J. Grant Mouser

• Ph.D.
• Professor (Assistant) at Troy University

The use of blood flow restriction is becoming more common and requires the use of individualized pressures in order to remain a safe and effective rehabilitation modality. Measuring limb occlusion pressure (LOP) allows the practitioner to set the restriction pressure so that full occlusion does not occur. Objective: Compare a research-grade clinica...

Blood flow restriction is growing in popularity as a tool for increasing muscular size and strength. Currently, guidelines exist for using blood flow restriction alone and in combination with endurance and resistance exercise. However, only about 1.3% of practitioners familiar with blood flow restriction applications have utilized it for vascular c...

Recommendations are that blood flow restriction (BFR) be applied relative to arterial occlusion pressure (AOP) to provide a similar stimulus. Purpose: Compare variability of the change in blood flow, shear rate, and discomfort between recommended relative pressures and an absolute pressure. Methods: During one visit, brachial arterial blood flo...

Objectives: To determine if different mechanisms, i.e., changes in one-repetition maximum (1RM) strength (Δ1RM) or vascular conductance (ΔVC), mediate changes in endurance (ΔEND) following training with 70% 1RM (70/0), 15% 1RM (15/0), and 15% 1RM with blood flow restriction using 40% (15/40) or 80% (15/80) arterial occlusion pressure. Design: Secon...

It is unclear how different applications of blood flow restriction (BFR) pressure alter blood flow characteristics. PURPOSE: The purpose of this study was to compare blood flow velocities and profiles with relative and absolute BFR pressures. METHODS: Over one visit, after 5-min of seated rest, arterial occlusion pressure (AOP) was measured with...

Green, MS, Kimmel, CS, Martin, TD, Mouser, JG, and Brune, MP. Effect of carbohydrate mouth rinse on resistance exercise performance. J Strength Cond Res XX(X): 000-000, 2020-A carbohydrate mouth rinse (CMR) has been shown to enhance short duration endurance performance and raises the possibility that a similar strategy could improve performance dur...

Within a golf swing, one aspect that stands out in each phase is the ability to maintain balance. Previous reports suggest that extrinsic factors, such as footwear, and intrinsic factors, such as muscular exertion level, have detrimental effects on human postural control. However, no studies have examined the effects of modern golf footwear on musc...

Background: According to the National Collegiate Athletic Association (NCAA) there are over 34,000 athletes who compete in baseball at the collegiate level. These individuals spend countless hours training to improve their ability at bat performance by use of a batting tee and their position preference. However, during a game situation an athlete m...

Although often used as a surrogate, comparisons between traditional blood pressure measurements and limb occlusion assessed via hand-held Doppler have yet to be completed. Using limb occlusion pressure as a method of assessing systolic pressure is of interest to those studying the acute effects of blood flow restriction, where the removal of the cu...

The periodization of resistance exercise is often touted as the most effective strategy for optimizing muscle size and strength adaptations. This narrative persists despite a lack of experimental evidence to demonstrate its superiority. In addition, the general adaptation syndrome, which provides the theoretical framework underlying periodization,...

The objective of this study was to determine differences in 2 distinct resistance training protocols and if true variability can be detected after accounting for random error. Individuals (n = 151) were randomly assigned to 1 of 3 groups: (i) a traditional exercise group performing 4 sets to failure; (ii) a group performing a 1-repetition maximum (...

Low-load exercise performed to or near task failure appears to result in similar skeletal muscle adaptations as low-load exercise with the addition of blood flow restriction (BFR). However, there may be a point where the training load becomes too low to stimulate an anabolic response without BFR. This study examined skeletal muscle adaptions to ver...

The purpose was to examine changes in the perceptual responses to lifting a very low load (15% one repetition maximum (1RM)) with and without (15/0) different pressures [40% (15/40) and 80% (15/80) arterial occlusion pressure] and compare that to traditional high load (70/0) resistance exercise. Ratings of perceived exertion (RPE) and discomfort we...

The purpose of this study was to compare the acute muscular response with resistance exercise between the following conditions [labeled (% one-repetition maximum/% arterial occlusion pressure)]: high-load (70/0), very low-load (15/0), very low-load with moderate (15/40), and high (15/80) blood flow restriction pressures. Twenty-three participants c...

Objective: The purpose of this study was to examine acute changes in muscle thickness (MTH) and echo-intensity (EI), following four sets of biceps curls, when it is known that the change in MTH is due entirely to swelling. Approach: Forty-nine resistance-trained men and women participated in this study. Individuals in the experimental group (n =...

Objective: To investigate vascular adaptations to eight weeks of resistance exercise, with and without different pressures of blood flow restriction (BFR), in the upper and lower body. Approach: Forty individuals (men=20, women=20) completed eight weeks of resistance exercise at very low loads (15% of one-repetition maximum (1RM)), with two leve...

Blood flow restriction training using a practical (non‐pneumatic) elastic‐cuff has recently increased in popularity. However, a criticism of this method is that the pressure applied and the amount of blood flow restriction induced is unknown. The aim was to quantify blood flow following the application of an elastic‐cuff and compare that to what is...

The purpose was to examine the acute skeletal muscle response to high load exercise and low‐load exercise with and without different levels of applied pressure (BFR). A total of 22 participants completed the following four conditions: elbow flexion exercise to failure using a traditional high load [70% 1RM, (7000)], low load [15% 1RM,(1500)], low l...

Objective: To examine the acute changes in blood flow and blood pressure of very low load knee extensor exercise (15% one repetition maximum (1RM)) with and without different levels of applied pressure to determine how these effects might differ from high load exercise. We also sought to examine if this differed between men and women. Approach:...

An inability to lift loads great enough to disrupt muscular blood flow may impair the ability to fatigue muscles, compromising the hypertrophic response. It is unknown what level of blood flow restriction (BFR) pressure, if any, is necessary to reach failure at very low-loads [i.e., 15% one-repetition maximum (1RM)]. The purpose of this study was t...

Introduction/background: To determine the influence of ultrasound probe tilt on reliability and overall changes in muscle thickness and echo-intensity. Materials and methods: Thirty-six individuals had a total of 15 images taken on both the biceps brachii and tibialis anterior muscles. These images were taken in 2° increments with the probe tilt...

Objectives: To investigate the skeletal muscle mass to fat-free mass (SM-FFM) ratio in female and male athletes, as well as to examine the relationship between ultrasound predicted SM and magnetic resonance imaging (MRI)-measured SM. Methods: Seven female track and field athletes (Female), 8 male collegiate swimmers (Male-G1) and 8 male collegia...

Objective: To determine whether the perceived tightness scale could be used to set sub-occlusive blood flow restriction pressures. A secondary aim was to determine variables that may impact individual ratings. Approach: One hundred and twenty participants completed three separate conditions in one limb within the upper and lower body. Participan...

It is proposed that, at very low loads, greater blood flow restriction (BFR) pressures might be required for muscular adaptation to occur. The cardiovascular and hyperemic response to very low loads combined with relative levels of BFR is unknown. Ninety-seven participants were recruited and assigned to 1 of 4 exercise conditions: 15% of 1-repetiti...

A training program consisting of working up to a one-repetition maximum (1RM) results in similar strength adaptations as traditional resistance exercise, while also decreasing the volume of work necessary to achieve this outcome. However, little is known regarding the cardiovascular adaptations to this type of training. Objective: To examine chroni...

Purpose: To determine the acute cardiovascular and perceptual responses of low-load exercise with or without blood flow restriction and compare those responses to that of moderately heavy exercise. Methods: Twenty-two participants completed unilateral elbow flexion exercise with a moderately heavy-load- [70% one-repetition maximum (1RM); 70/0] a...

Purpose Studies examining perceptual and arterial occlusion responses between blood flow restricted exercise and high load exercise often prescribe an arbitrary number of repetitions, making it difficult for direct comparisons. Therefore, the purpose of this study was to compare these protocols when performed to volitional failure. Methods Individ...

Laurentino, GC, Loenneke, JP, Mouser, JG, Buckner, SL, Counts, BR, Dankel, SJ, Jessee, MB, Mattocks, KT, Iared, W, Tavares, LD, Teixeira, EL, and Tricoli, V. Validity of the handheld Doppler to determine lower-limb blood flow restriction pressure for exercise protocols. J Strength Cond Res XX(X): 000-000, 2018-Handheld (HH) Doppler is frequently us...

Background A training program consisting of only one-repetition maximum (1RM) training results in similar strength adaptations as traditional resistance exercise. However, little is known regarding the affective or behavioral responses to this type of training. Aim To examine the affective and behavioral response to either a traditional resistance...

Introduction: World powerlifting records within the super heavyweight class are typically held by those with not only the greatest absolute muscle strength but also the greatest amount of skeletal muscle mass (SM). Case Presentation: We examined the absolute and relative SM and muscle architecture of a 30 year old drug-free raw (i.e. without the us...

With repeated exposure to postural perturbations the human postural control system can adapt and create efficient strategies to counteract these perturbations. The Motor Control Test (MCT) is commonly used to elicit reactionary postural movements. Though this device has been assessed for possible learning effects and reliability of composite scores...

Blood flow restriction by itself or in combination with exercise has been shown to produce beneficial adaptations to skeletal muscle. These adaptations have been observed across a range of populations, and this technique has become an attractive possibility for use in rehabilitation. Although there are concerns that applying blood flow restriction...

Objectives: To examine the amount of absolute and relative skeletal muscle mass (SM) in large sized athletes to investigate the potential upper limit of whole body muscle mass accumulation in the human body. Methods: Ninety-five large-sized male athletes and 48 recreationally active males (control) had muscle thickness measured by ultrasound at...

Purpose: To examine the hemodynamic responses to relative pressures using two commonly used cuffs (10 and 12 cm). Methods: In a random order over two laboratory visits, one cuff was applied to the right proximal thigh of the participant (men = 17, women = 14), and arterial occlusion pressure (AOP) was measured. Ultrasound measures of blood flow,...

To determine the effects of load and blood flow restriction (BFR) on muscular responses, we asked 12 participants to perform chest presses under four different conditions [30/0, 30/40, 50/0, and 50/40, presented as percentage one-repetition maximum (1RM)/percentage arterial occlusion pressure (AOP)]. Muscle thickness increased pre- to post-exercise...

When restricting blood flow for the purpose of increasing or maintaining muscle fitness, the aim is to reduce the amount of arterial flow into the limb and restrict the venous flow out of the limb. Doing so has been shown to elicit positive adaptations with regards to skeletal muscle size, and strength, while some evidence also eludes to beneficial...

Background: The sex difference in 100-m sprint performance between the world's best athletes is approximately 10%. We hypothesized that skeletal muscle mass (SM) relative to body mass may be a major factor contributing to this difference. The aim of this study was to examine the sex difference in absolute and relative SM and sprint performance in...

It is well known that resistance exercise results in increased muscle strength, but the cause of the improvement is not well understood. It is generally thought that initial increases in strength are caused by neurological factors, before being predominantly driven by increases in muscle size. Despite this hypothesis, there is currently no direct e...

There may be some individuals who do not adapt favorably to an exercise stimulus. This is most commonly determined by assessing the error of the measurement across two separate testing sessions separated by a short period of time. It has been recommended that this error be assessed over the same time frame as the intervention. We examined the 24-h...

We read with great interest the recent study by Franchi et al. (1) which concluded that changes in muscle thickness measured via ultrasound tracked well with changes in anatomical cross sectional area measured via magnetic resonance imaging (MRI). While this is a very important study due to the widespread use of ultrasound in training studies, ther...

Many reviews conclude that metabolites play an important role with respect to muscle hypertrophy during resistance exercise, but their actual physiologic contribution remains unknown. Some have suggested that metabolites may work independently of muscle contraction, while others have suggested that metabolites may play a secondary role in their abi...

A number of reviews have concluded that resistance training is beneficial for improving sports performance despite the inclusion of studies which do not actually measure a performance outcome (i.e. a timed trial). The purpose of this review was to examine only those studies which would allow us to infer the benefits of resistance training on improv...

The application of blood flow restriction during low-load resistance exercise has been shown to induce muscle growth with high or low restriction pressures, however, loads lower than 20% one-repetition maximum (1RM) remain unexplored. Fourteen trained individuals completed six elbow flexion protocols involving three different loads (10%, 15%, and 2...

Purpose: Our laboratory recently demonstrated that post-exercise blood flow restriction attenuated muscle hypertrophy only in females, which we hypothesized may be due to alterations in post-exercise blood flow. The aim of this study is to test our previous hypothesis that sex differences in blood flow would exist when employing the same protocol....

Resistance exercise is believed to be important for improving several biomarkers of health and contributing to decreased all-cause mortality. However, a careful examination of the literature reveals a growing body of cross-sectional studies finding stronger associations between strength independent of physical activity on these various outcomes and...

Blood flow restriction (BFR) in combination with exercise has been used to increase muscle size and strength using relatively low loads (20%–30% 1-repetition maximum (1RM)). In research, the range of applied pressures based on a percentage of arterial occlusion pressure (AOP), is wide. The purpose of the study is to measure the blood flow response...

IntroductionThe blood flow response to relative levels of blood flow restriction (BFR) across varying cuff widths is not well documented. With the variety of cuff widths and pressures reported in the literature, the effects of different cuffs and pressures on blood flow require investigation. PurposeTo measure blood pressure using three commonly us...

This study sought to compare cardiovascular and perceptual responses to blood flow restriction (BFR) exercise using various pressure and load combinations. Fourteen participants completed four sets of BFR elbow flexion using 10, 15 and 20% 1RM with 40 and 80% arterial occlusion pressure (AOP). AOP was measured before and after exercise. Perceived e...

Studies examining resistance training are of importance given that increasing or maintaining muscle mass aids in the prevention or attenuation of chronic disease. Within the literature, it is common practice to administer a set number of target repetitions to be completed by all individuals (i.e. 3 sets of 10) while setting the load relative to eac...

Strength increases following training are thought to be influenced first by neural adaptions, and second by large contributions from muscle growth. This is largely based on the idea that muscle growth is a slow process and a plateau in muscle growth would substantially hinder long term increases in strength. Our purpose was to review the literature...

The principle of progressive overload must be adhered to for individuals to continually increase muscle size with resistance training. While the majority of trained individuals adhere to this principle by increasing the number of sets performed per exercise session, this does not appear to be an effective method for increasing muscle size once a gi...

Purpose: To determine if muscle growth is important for increasing muscle strength or if changes in strength can be entirely explained from practicing the strength test. Methods: Thirty-eight untrained individuals performed knee extension and chest press exercise for 8 weeks. Individuals were randomly assigned to either a high-volume training gr...

Introduction: Blood flow restriction (BFR), the application of external pressure to occlude venous return and restrict arterial inflow, has been shown to increase muscular size and strength when combined with low-load resistance exercise. BFR in the research setting uses a wide range of pressures, applying a pressure based upon an individual's sys...

Aim: The time-course for changes in muscle size and strength is not well understood, particularly in women. In addition, contributions of muscle size to strength are commonly assessed utilizing a pre-post change score; however, a more appropriate within-subject correlational analysis has never been used. Methods: To determine the time-course for...

Objectives: To examine the original work of Hans Selye, as well as the original papers through which the GAS was established as a central theory for periodized resistance exercise. Methods: We conducted a review of Selye's work on the GAS, as well as the foundational papers through which this concept was applied to resistance exercise. Results/...

The purpose of this study was to determine acute physiological and perceptual responses to two commonly implemented blood flow restriction protocols. Using a within-subject design, 15 participants (age ∼25) performed four sets of unilateral elbow flexion with each arm. One arm exercised using a 3-cm elastic cuff inflated to 160 mmHg, whereas the ot...

Muscle strength is often measured through the performance of a one-repetition maximum (1RM). However, we that feel a true measurement of ‘strength’ remains elusive. For example, low-load alternatives to traditional resistance training result in muscle hypertrophic changes similar to those resulting from traditional high-load resistance training, wi...

To investigate the acute responses to blood flow-restricted (BFR) exercise across low, moderate and high relative pressures. Muscle thickness, maximal voluntary contraction (MVC) and electromyography (EMG) amplitude were assessed following exercise with six different BFR pressures: 0%, 10%, 20%, 30%, 50% and 90% of arterial occlusion pressure (AOP)...

Objectives: To investigate the influence of time, within and between days, on arterial occlusion pressure and to determine whether the variability resembles the oscillatory pattern of bSBP. Design: Test-retest. Methods: Twenty-two participants completed four testing sessions at 08:00 and 18:00h, 48h apart. Arm circumference, bSBP, and brachial...

Introduction: Blood flow restriction has been shown to augment muscle activation and increase muscle size when combined with low-load training; however, much less is known on whether blood flow restriction can augment muscle activation during high-load exercise. Purpose: To determine whether applying blood flow restriction can augment muscle act...

Recent studies have investigated relative pressures that are applied during blood flow restriction exercise ranging from 40%-90% of resting arterial occlusion pressure; however, no studies have investigated relative pressures below 40% arterial occlusion pressure. The purpose of this study was to characterize the cardiovascular and perceptual respo...

The point at which an individual becomes resistance "trained" is not well defined in the literature. Some studies have defined training status as having engaged in consistent resistance training activities for a given period of time, whereas others base inclusion criteria on strength levels alone, or levels of strength in combination with training...

Purpose: To examine the swelling response and other markers of muscle damage throughout the early portions of a training program (Experiment 1). We also determined if a "swollen" muscle could swell further following additional exercise (Experiment 2). Methods: Nine males performed four sets of biceps curls (or time-matched rest on control arm) a...

Low-load resistance exercise with the blood flow restriction (BFR) has been shown to increase muscle size similar to that of traditional high-load resistance training. Throughout the BFR literature, there is a vast difference between the quantity of young females included in the literature compared to young males, older males and older females. The...

In this paper we revisit a topic originally discussed in 1955, namely the lack of direct evidence that muscle hypertrophy from exercise plays an important role in increasing strength. To this day, long-term adaptations in strength are thought to be primarily contingent on changes in muscle size. Given this assumption, there has been considerable at...

Purpose: Applying blood flow restriction during low-load resistance training has been shown to augment muscle hypertrophy which has been attributed to metabolic accumulation. It remains unknown, however, whether metabolites can augment muscle growth when maintained post-exercise. Methods: Thirteen untrained individuals (6 males and 7 females) pe...

Objectives: Studies comparing multiple groups (i.e., experimental and control) often examine the efficacy of an intervention by calculating within group effect sizes using Cohen's d. This method is inappropriate and largely impacted by the pre-test variability as opposed to the variability in the intervention itself. Furthermore, the percentage ch...

Objective: Examine the association between physiologic testosterone levels with lean and fat mass. Methods: Data from the 1999-2000 NHANES were used (n=252 men; 18-85yrs). Testosterone and SHBG values were obtained by a morning blood sample. Body composition was measured by DXA. Multivariable linear regression was used to compute unadjusted, min...

The purpose of this study was to examine the acute skeletal muscle and perceptual responses to blood flow restriction (BFR) exercise to failure between narrow nylon and elastic inflatable cuffs at rest and during exercise. Torque and muscle thickness was measured pre, post, and 5, 20, 40, and 60 min post-exercise with muscle activation being measur...

ACSM 2016