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PURPOSE: To examine the effects of moderate load exercise with and without blood flow restriction on strength, power and repeated sprint ability, along with acute and chronic salivary hormonal parameters. METHODS: Twenty male semi-professional rugby union athletes were randomized to a lower-body blood flow restricted intervention (an occlusion cuff inflated to 180 mmHg worn intermittently on the proximal thighs) or a control intervention that trained without occlusion in a cross-over design. Experimental sessions were performed three times a week for three weeks with 5 sets of 5 repetitions of bench press, leg squat and pull-ups performed at 70% of 1-repetition maximum. RESULTS: Greater improvements were observed (occlusion training vs control) in bench press (5.4±2.6 vs 3.3±1.4kg), squat (7.8±2.1 vs 4.3±1.4kg), maximum sprint time (-0.03±0.03 vs -0.01±0.02s) and leg power (168±105 vs 68±50W). Greater exercise-induced salivary testosterone (Effect Size: 0.84 to 0.61) and cortisol responses (ES: 0.65 to 0.20) were observed following the occlusion intervention sessions compared to the non-occluded controls; however the acute cortisol increases were attenuated across the training block.. CONCLUSIONS: Occlusion training can potentially improve the rate of strength training gains and fatigue resistance in trained athletes, possibly allowing greater gains from lower loading which could be of benefit during high training loads, in competitive seasons, or in a rehabilitative setting. The clear improvement in bench press strength resulting from lower-body occlusion suggests a systemic effect of blood flow restricted training.
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“Three Weeks of Occlusion Training can Improve Strength and Power in Trained Athletes”
by Cook CJ, Kilduff LP, Beaven CM
International Journal of Sports Physiology and Performance
© 2013 Human Kinetics, Inc.
Note. This article will be published in a forthcoming issue of the
International Journal of Sports Physiology and Performance. The
article appears here in its accepted, peer-reviewed form, as it was
provided by the submitting author. It has not been copyedited,
proofread, or formatted by the publisher.
Section: Original Investigation
Article Title: Three Weeks of Occlusion Training can Improve Strength and Power in
Trained Athletes
Authors: Christian J. Cook1,2,3, Liam P. Kilduff4, and C. Martyn Beaven5,6
Affiliations: 1 United Kingdom Sports Council, London, U.K. 2 Hamlyn Centre, Institute of
Global Health Innovation, Imperial College, London, U.K. 3 Sport, Health and Exercise
Science, University of Bath, Bath, U.K. 4 Applied Sports Technology, Exercise and Medicine
Research Centre, Swansea University, Swansea, UK. 5Swedish Winter Sports Research
Centre, Mittuniversitetet, Östersund, Sweden. 6Swedish Olympic Committee, Sweden.
Journal: International Journal of Sports Physiology and Performance
Acceptance Date: April 4, 2013
©2013 Human Kinetics, Inc.
“Three Weeks of Occlusion Training can Improve Strength and Power in Trained Athletes”
by Cook CJ, Kilduff LP, Beaven CM
International Journal of Sports Physiology and Performance
© 2013 Human Kinetics, Inc.
Three Weeks of Occlusion Training can Improve Strength and Power in Trained Athletes
Christian J. Cook1,2,3, Liam P. Kilduff4,C. Martyn Beaven5,6
Original Investigation
1 United Kingdom Sports Council, London, U.K.
2 Hamlyn Centre, Institute of Global Health Innovation, Imperial College, London, U.K.
3 Sport, Health and Exercise Science, University of Bath, Bath, U.K.
4 Applied Sports Technology, Exercise and Medicine Research Centre, Swansea University,
Swansea, UK.
5Swedish Winter Sports Research Centre, Mittuniversitetet, Östersund, Sweden.
6Swedish Olympic Committee, Sweden.
Christopher Martyn Beaven
Nationellt Vintersportcentrum
Mittuniversitetet
831 25 Östersund
Sweden
Phone: +46 (0) 70 322 705
Fax: +46 (0) 63 165 740
Email: Martyn.Beaven@miun.se
Running Head: Occlusion and Strength Training
Abstract Word Count: 250 words (limit 250).
Text Only Word Count: 3325 (limit 3500).
Number of Tables and Figures: 3
“Three Weeks of Occlusion Training can Improve Strength and Power in Trained Athletes”
by Cook CJ, Kilduff LP, Beaven CM
International Journal of Sports Physiology and Performance
© 2013 Human Kinetics, Inc.
ABSTRACT
Purpose: To examine the effects of moderate load exercise with and without blood flow
restriction on strength, power and repeated sprint ability, along with acute and chronic
salivary hormonal parameters. Methods: Twenty male semi-professional rugby union
athletes were randomized to a lower-body blood flow restricted intervention (an occlusion
cuff inflated to 180 mmHg worn intermittently on the proximal thighs) or a control
intervention that trained without occlusion in a cross-over design. Experimental sessions were
performed three times a week for three weeks with 5 sets of 5 repetitions of bench press, leg
squat and pull-ups performed at 70% of 1-repetition maximum. Results: Greater
improvements were observed (occlusion training vs control) in bench press (5.4±2.6 vs
3.3±1.4kg), squat (7.8±2.1 vs 4.3±1.4kg), maximum sprint time (-0.03±0.03 vs -0.01±0.02s)
and leg power (168±105 vs 68±50W). Greater exercise-induced salivary testosterone (Effect
Size: 0.84 to 0.61) and cortisol responses (ES: 0.65 to 0.20) were observed following the
occlusion intervention sessions compared to the non-occluded controls; however the acute
cortisol increases were attenuated across the training block.. Conclusions: Occlusion training
can potentially improve the rate of strength training gains and fatigue resistance in trained
athletes, possibly allowing greater gains from lower loading which could be of benefit during
high training loads, in competitive seasons, or in a rehabilitative setting. The clear
improvement in bench press strength resulting from lower-body occlusion suggests a
systemic effect of blood flow restricted training.
“Three Weeks of Occlusion Training can Improve Strength and Power in Trained Athletes”
by Cook CJ, Kilduff LP, Beaven CM
International Journal of Sports Physiology and Performance
© 2013 Human Kinetics, Inc.
INTRODUCTION
In many team sports, including rugby, there is an onus on short-term training blocks
to enhance aspects of functional strength as trainers and athletes often only have short time-
frames and limited opportunities to enhance multiple aspects of physical conditioning.1
During high training phases and in competitive seasons it is necessary to be mindful of total
load on athletes and their requirement to recover between games. In addition, short-term
training blocks are necessarily performed concurrently with other training practices that
contribute to overall performance. Thus, it is vital that the exercise prescription during such
blocks is as effective as possible in eliciting positive functional gains.
Resistance training with low loads (20% of 1-repetition maximum), in conjunction
with an applied occlusion to restrict blood flow, has been shown to rapidly increase muscle
size and strength in athletic populations.2,3 A load and intensity as low as that acheived with
walking, when combined with blood-flow restriction (BFR), has been demonstrated to elicit
significant improvements in knee joint strength and leg muscle size.4 The enhanced
hypertrophy and strength gains resulting from BFR training have been associated with acute
increases in growth hormone5,6 and decreased myostatin mRNA expression.7 Further,
exercise with BFR elicits increased acute metabolic stress (lactate and cortisol), activation of
the mTOR signalling pathway,8,9 increased muscle fibre recruitment,10 and promotes
angiogenesis.11
The role of endogenous testosterone in affecting resistance training outcomes is well
established insofar as testosterone levels within the normal physiological range are requisite,
or permissive, for the normal adaptive response to resistance exercise.12-14 Previous research
investigating testosterone responses to BFR training has demonstrated no intervention effect
when compared to exercising without BFR despite observed increases in other putatively
“Three Weeks of Occlusion Training can Improve Strength and Power in Trained Athletes”
by Cook CJ, Kilduff LP, Beaven CM
International Journal of Sports Physiology and Performance
© 2013 Human Kinetics, Inc.
anabolic hormones.6,15 However, these studies utilised blood, rather than salivary, sampling
which can influence steroid hormone concentrations16 and did not involve intermittent
occlusion. In contrast, we utilised an intermittent occlusion intervention and saliva samples
that are non-invasive and recognised to reflect free steroid levels capable of interacting with
hormone receptors.17
Therefore, the purpose of this investigation was to compare the functional training
effects and salivary hormonal responses following intermittent BFR training with non-
occluded training across an eight week pre-season period for trained male rugby athletes. It
was hypothesized that, compared to non-occluded training, BFR training would elicit: 1)
greater strength gains and; 2) exaggerated exercise-induced alterations in salivary
testosterone and cortisol, due to the provision of an additional stressor.
METHODS
Subjects
Twenty male semi-professional rugby union athletes (mean ± SD, age: 21.5 ± 1.4 yr;
height: 1.84 ± 0.05 m; body mass: 95.6 ± 10.4 kg) from the same club that played a range of
positions were recruited and provided written informed consent. All players had a minimum
of two years of resistance training experience and were currently within the pre-season phase
of their training programs.
Design
The athletes were divided into two groups (n=10) with a similar spread of age, body
mass, height, playing position and existing strength and speed performance (Table 1). The
study was tailored to form an 8-week resistance training block for the athletes to achieve
functional strength and power gains that they would normally focus on during pre-season
“Three Weeks of Occlusion Training can Improve Strength and Power in Trained Athletes”
by Cook CJ, Kilduff LP, Beaven CM
International Journal of Sports Physiology and Performance
© 2013 Human Kinetics, Inc.
resistance training. The study protocol was approved by the ethics committee of the local
university.
During the time of study all athletes had set dietary plans that were consistent across
the training blocks and were designed to meet their bodyweight and activity needs. Athletes
were encouraged to ensure they got a minimum of 8 hr sleep, and a self-reported log
suggested they achieved this regularly. Caffeine and other fluid consumption were similar
across both training blocks, while alcohol consumption was low or absent.
Methodology
Before commencing training all athletes attended two consecutive days of testing to
determine initial strength, power, speed, and speed endurance. All athletes were familiar with
the testing protocols from their prior training. The athletes were instructed not to take any
anti-inflammatory drugs and refrain from consuming alcohol in the 48 hours prior to each
testing day. In addition, the players were instructed to consume at least 750 ml of fluid, avoid
consumption of caffeinated products, and to replicate their dietary consumption on the
morning of testing days.
Strength
On Day 1 of testing, athletes assembled at 11:00 a.m. having consumed breakfast and
a minimum of 750 ml fluid, and having been encouraged to have slept at least 8 hr. A
standard 15 minute warm up was performed and was comprised of 5 minutes on a rowing
ergometer, 5 minutes on a cycling ergometer (both at target heart rates of 120-130 beats·min-1
measured by heart rate monitors; Polar S810i, Polar Oy, Kempele, Finland), and 5 minutes of
mixed calisthenics.
Athletes then performed leg squats to just below parallel in a controlled manner under
the supervision of a qualified strength-conditioning coach. Using historical records of
“Three Weeks of Occlusion Training can Improve Strength and Power in Trained Athletes”
by Cook CJ, Kilduff LP, Beaven CM
International Journal of Sports Physiology and Performance
© 2013 Human Kinetics, Inc.
individual performance, athletes completed the following squats based on individual
percentage of 1-repetition maximum (1-RM): 5 x 50%, 3 x 60%, 2 x 80% then 1 x 90%, 1 x
95%, 1 x 100%. If successful at the 1 x 100% lift, the athlete continued to increase the weight
in increments of 2.5 kg until failure. The best lift was recorded as the athlete’s 1-RM.
Athletes were allowed 5 minutes passive recovery between attempts. After a further 5
minutes rest, this routine was repeated to determine each individual’s bench press 1-RM. On
average, athletes performed three maximum attempts to determine the true 1-RM.
Power and Speed
On Day 2 of testing, the athletes again assembled at 11:00 a.m. and performed the
same standard warm-up as on Day 1. They then performed three maximal effort unloaded
countermovement jumps, with the arms akimbo throughout the movement, on a force plate
sampling at 1000 Hz (Kistler Instrument Corporation, Amherst, NY, U.S.A.) with the best
jump being recorded to calculate lower body instantaneous power as previously described.18
One minute of passive recovery was allowed between jump attempts.
Following the conclusion of jump testing, athletes undertook three 40 m warm-up
sprints at 50%, 65%, and 80% of a self-perceived maximum pace. Recovery between sprints
consisted of walking the distance back to the start. Following a further one minute of rest, the
athletes performed 5 x 40 m maximal sprints and speed was assessed via electronic timing
light gates (Brower Timing System, Salt Lake City, UT, U.S.A.). One minute separated each
maximal sprint effort. Best sprint time was recorded and performance maintenance was
calculated based on the change in sprint speed from the first to last sprint [(Sprint #1/Sprint
#5)*100].
“Three Weeks of Occlusion Training can Improve Strength and Power in Trained Athletes”
by Cook CJ, Kilduff LP, Beaven CM
International Journal of Sports Physiology and Performance
© 2013 Human Kinetics, Inc.
Training Blocks
The two groups were randomly assigned to one of the two training interventions in a
counterbalanced crossover fashion. Each training block was 3 weeks long and included nine
experimental resistance training sessions. All training sessions were performed at 9:00 a.m.
Standard Training
After completing the standard warm-up described earlier, the athletes performed three
exercises (leg squat, bench press and weighted pull-up) at 70% of their individually assessed
1-RM. Five sets of five repetitions were performed with 90 seconds passive rest between sets
and 3 minutes between exercises.
Blood Flow Restricted (BFR) Training
The BFR training was identical to the standard training above, except that lower-limb
blood flow was restricted with an occlusion cuff (width 10.5 cm) inflated to 180 mmHg. The
cuff was only inflated during exercise and was deflated during the inter-set and inter-exercise
rest periods (intermittent occlusion). Note that the lower-body occlusion cuff was worn
bilaterally at the most proximal portion of the thigh during all three exercises.
Hormone assessment
Saliva samples were collected before and after the first experimental training session
of each week. For each of their twelve samples, participants were asked to expectorate 2 ml
of saliva into a sterile container before beginning their training session. Samples were stored
at 20°C until assay. Salivary steroid samples were taken in this study as they are minimally
invasive and have the advantage of reflecting free steroid concentrations, and are reported to
be more physiologically relevant than total blood levels.17 To minimize the possibility of any
blood contamination of saliva, which would result in an overestimation of hormone
concentrations, the players were advised to avoid brushing their teeth, drinking hot fluids or
“Three Weeks of Occlusion Training can Improve Strength and Power in Trained Athletes”
by Cook CJ, Kilduff LP, Beaven CM
International Journal of Sports Physiology and Performance
© 2013 Human Kinetics, Inc.
eating hard foods (e.g. apples) in the 2 hr before providing their sample. Saliva samples were
analyzed in duplicate for testosterone and cortisol using commercial enzyme-immunoassay
kits as per manufacturer’s instructions (Salimetrics Europe Ltd., Suffolk, U.K.). The
detection limits for the testosterone and cortisol assays were 17 pmol/L and 33 nmol/L
respectively, with intra- and inter-assay coefficients of variation were less than 9.1%.
Statistical Analyses
Changes in the mean of each measure were used to assess magnitudes of effects by
dividing the changes by the appropriate between-athlete standard deviations. Pairwise
comparisons were made between training conditions, and differences were interpreted in
relation to the likelihood of exceeding the smallest worthwhile effect with individual change
thresholds for each variable. Magnitudes of the standardized effects were interpreted using
thresholds of 0.2, 0.6, 1.2 and 2.0 for small, moderate, large, and very large respectively.19
Standardized effects of between -0.19 and 0.19 were termed trivial. Quantitative chances of
higher or lower differences were evaluated qualitatively as follows: <1%, almost certainly
not; 15%, very unlikely; 525%, unlikely; 2575%, possible; 7595%, likely; 9599%, very
likely; >99%, almost certain. To make inferences about the large-sample value of an effect,
the uncertainty in the effect was expressed as 90% confidence limits (CL). An effect was
deemed unclear if the confidence interval overlapped the thresholds for both small positive
and negative effects. The significance level was set at p≤ 0.05. An intra-class correlation
(ICC) of 0.98 for power in a countermovement jumps has been demonstrated previously.20
Similarly, high reliability for the 40 m sprint (ICC= 0.91) and strength measures (ICC≥ 0.96)
used in the current study have been reported in trained rugby athletes.21
“Three Weeks of Occlusion Training can Improve Strength and Power in Trained Athletes”
by Cook CJ, Kilduff LP, Beaven CM
International Journal of Sports Physiology and Performance
© 2013 Human Kinetics, Inc.
RESULTS
All athletes completed the experimental protocol. Over the 8-week pre-season period,
mean improvements (±90% CL) were observed in bench press (8.6 ±5.8 kg; ES: 0.78) and leg
squat (12.0 ±6.7 kg; ES: 0.93) exercises. When the two training interventions were compared,
occlusion resulted in significantly greater improvements in bench press (p= 0.0044; 1.4±
0.8%), squat (p= 1.03x10-6; 2.0 ±0.6%), maximal sprint times (p= 0.0162; 0.4 ± 0.3%), and
countermovement jump power (p= 0.0003; 1.8± 0.7%) (Figure 1). The occlusion intervention
also significantly improved performance maintenance in the repeated sprint test by 0.74
±0.37% (p= 0.0023) compared to the non-occluded intervention.
Salivary hormone concentrations prior to the first experimental session were
118.7±14.2 pg/ml for testosterone and 2.15±0.7 ng/ml for cortisol. The salivary testosterone
and cortisol exercise-induced response data from Sessions 1, 4 and 7 (the first session of each
week within each 3-week training block) are shown in Figure 2. Large to very large increases
in testosterone were observed in response to these 3 BFR training sessions (ES: 1.50 to 2.19)
in comparison to moderate increases in response to non-occluded training (ES: 0.73 to 1.19).
The acute testosterone increases as a result of BFR training were consistently and almost
certainly (likelihoods > 99%) greater than the increases in the non-occluded training
situation. Overall, significant associations were also observed between the mean acute
salivary testosterone response to exercise and leg squat strength (r= 0.68; p= 0.0005), bench
press strength (r= 0.45; p= 0.0233), and countermovement jump power production gains (r=
0.46; p= 0.0201).
In contrast to the testosterone data, the cortisol responses to BFR were significantly
attenuated over the 3 week training period (p= 1.12x10-5). Specifically, the qualitative chance
that the increase in cortisol was greater in response to BFR fell from almost certain (99.99%;
ES: 0.65) in the first week, to only possible (49.77%; ES: 0.20) in the third week. The pre-
“Three Weeks of Occlusion Training can Improve Strength and Power in Trained Athletes”
by Cook CJ, Kilduff LP, Beaven CM
International Journal of Sports Physiology and Performance
© 2013 Human Kinetics, Inc.
exercise salivary testosterone was observed to significantly increase from 120.5±13.2 to
130.1±13.6 pg/ml (8.0%; p= 0.0284) across the training blocks during the BFR intervention,
while a non-significant decrease from 120.5±13.2 to 117.1±12.3 pg/ml (-2.4%; p= 0.5268)
was seen across the same time period when no occlusion was applied. This chronic
testosterone change represented a clear difference (ES: 0.85 ±0.82) between the two
interventions.
DISCUSSION
Our data demonstrate that the intermittent application of an 180 mmHg occlusive
stimulus to the lower-limbs during exercise, significantly enhances multiple training gains
from 3-week structured training blocks when compared to non-occluded training in trained
male athletes. The ability of bilateral BFR training applied to the lower-body to enhance
upper-body strength gains is suggestive of a systemic mechanism that is not limited to
localised hypoxia or metabolite accumulation. Previous research has shown that growth
hormone secretion is significantly increased following BFR training at low intensity loads.5,6,8
Here we present the novel finding that the bilateral occlusive intervention was also associated
with differential hormonal profiles, with large elevations in free testosterone that were
maintained across the training block and cortisol responses that were attenuated over the
training period.
Madarame and colleagues,15 have demonstrated a cross-transfer effect with an
increase in cross-sectional area of the elbow flexor muscles when leg exercise was performed
with BFR. A similar phenomenon has been demonstrated in trained athletes where BFR
applied to the limbs produced an increase in upper- and lower-chest girth and an increase in
bench press strength.3 Our data showing an improvement in bench press strength corroborate
these findings by demonstrating that the application of an occlusion cuff to the lower-limbs
“Three Weeks of Occlusion Training can Improve Strength and Power in Trained Athletes”
by Cook CJ, Kilduff LP, Beaven CM
International Journal of Sports Physiology and Performance
© 2013 Human Kinetics, Inc.
can modulate adaptation in the upper body. It should also be noted that the strength gains
seen in the current study, and those reported by Yamanaka et al.3 in trained athletes, were
achieved in relatively short time frames (3 to 4 weeks) and only 9 to 12 experimental
intervention sessions, suggestive of an accelerated time course of adaptation compared to
non-occluded training.22
A number of mechanisms have the potential to explain the systemic adaptations seen
in response to the combination of BFR and resistance exercise. Elevated systemic blood
lactate levels have been consistently reported following occlusion.6,8,10 The low pH resultant
from elevated lactate stimulates sympathetic nerve activity and this pathway has been shown
to be involved in the secretion of human growth hormone.23 Large increases in growth
hormone concentration have been commonly reported with BFR training4-6,8 and, although
the role of growth hormone in muscular hypertrophy is equivocal, it does appear to have
some permissive effects when combined with resistance exercise.24
The hypoxic and acidic intramuscular milieu resulting from BFR has also been
hypothesised to result in additional motor unit recruitment10 and electromyographic data has
demonstrated enhanced muscle activation in the pectoralis major in response to BFR of the
upper limbs.25 Furthermore, BFR combined with low-intensity resistance exercise has been
shown to potentiate the skeletal muscle expression of mRNA responsible for angiogenesis,11
attenuate the mRNA expression of proteolytic transcripts,7 as well as enhance the
phosphorylation of downstream targets of the mTOR signalling pathway, extracellular signal-
regulated kinases, and increase muscle protein synthesis.8,9 It is also known that the
application of an intermittent ischemic stimulus to the upper arm using a blood pressure cuff
can produce cardioprotective effects in humans 26. All of these mechanisms demonstrate the
potential of BFR training to elicit remote training effects.
“Three Weeks of Occlusion Training can Improve Strength and Power in Trained Athletes”
by Cook CJ, Kilduff LP, Beaven CM
International Journal of Sports Physiology and Performance
© 2013 Human Kinetics, Inc.
Our study shows for the first time consistent and occlusion-dependent elevations in
salivary testosterone immediately following the resistance exercise sessions. Although the
dose-reliance hypothesis of testosterone in relation to muscle hypertrophy via protein
accretion, has been challenged,27 data does strongly suggest that a testosterone concentration
within the normal physiological range is requisite for a normal adaptive response to
resistance exercise.12,14 The correlations observed in the current work between acute
testosterone responses and functional strength gains agree with earlier work demonstrating
that elevated testosterone concentrations during exercise are related to improved
adaptation.13,14,28 As a result, testosterone can be described as possessing a permissive role in
actualising specific functional adaptations.29
It should be noted that previous studies investigating BFR have failed to observe
acute testosterone increases.6,15,24,30 It is possible that the more intense nature of the exercise
prescribed (70% of 1-RM), the intermittent nature of the occlusive stimulus, and/or the
sampling methodology (saliva vs plasma), contributed to the different results observed in this
study. Saliva samples may provide more physiologically relevant endocrine information as
they empirically reflect the free steroid levels capable of interacting with hormone receptors
17 and can exhibit a more dynamic response to exercise than the total blood hormone
concentrations.31 It is also reasonable to assume that the physiological phenomena associated
with numerous large and rapid reperfusion cycles in between exercise sets would differ from
those experienced with a continuous occlusion protocol.
Salivary cortisol was also observed to increase in response to both occluded and non-
occluded training with larger increases resulting from BFR training. It seems reasonable to
speculate that the addition of occlusion imposes additional (non-weight load dependent)
metabolic stress with similar results having been previously observed in response to BFR
exercise.8,30 Interestingly, the cortisol response to BFR training was attenuated across the 3-
“Three Weeks of Occlusion Training can Improve Strength and Power in Trained Athletes”
by Cook CJ, Kilduff LP, Beaven CM
International Journal of Sports Physiology and Performance
© 2013 Human Kinetics, Inc.
week training block (albeit only to the level seen in the non-occluded training) while the
cortisol response to the non-occluded training remained relatively consistent. This attenuation
is probably indicative of a stress adaptation to the BFR exercise and the degree of
familiarisation or the salivary collection method may partially explain the lack of cortisol
responses observed in an earlier studies4,6 which contrast our data.
PRACTICAL APPLICATIONS
Our data demonstrate that bilateral lower-limb BFR training was more beneficial than
traditional resistance training in terms of increasing strength, power and speed measures in
trained male athletes over a relatively short training 3-week training block. These results are
suggestive of an advantage of combining occlusion with moderate resistance loads (70% 1-
RM) in eliciting strength and power gains during an intense training phase or potentially
within a competitive season. It is also worth considering the potential benefits of BFR
training on athletes returning from injury or those who are not able to tolerate high loads due
to tendon and joint loading issues. We also demonstrate herein that the significant functional
benefits of BFR training in an elite group correlate with enhanced salivary testosterone
responses to the exercise sessions. While any causal relationship remains equivocal, it is
apparent that acute hormonal elevations may contribute to the cross-transfer signalling effects
observed with increases in upper-body strength in response to the lower-body occlusive
stimulus.
“Three Weeks of Occlusion Training can Improve Strength and Power in Trained Athletes”
by Cook CJ, Kilduff LP, Beaven CM
International Journal of Sports Physiology and Performance
© 2013 Human Kinetics, Inc.
CONCLUSIONS
Bilateral lower-limb BFR training with a moderate load produced significant benefits
compared to non-occluded training and thus can be considered an effective training stimulus
capable of eliciting functional improvements in well-trained athletes. The distinct salivary
hormonal profile associated with BFR training, and the observed correlation between
testosterone and strength and power measures, are suggestive of an important role for
endogenous steroids in actualising functional gains.
ACKNOWLEDGEMENTS
We wish to express our gratitude for the time and effort given freely by squad members and
management.
“Three Weeks of Occlusion Training can Improve Strength and Power in Trained Athletes”
by Cook CJ, Kilduff LP, Beaven CM
International Journal of Sports Physiology and Performance
© 2013 Human Kinetics, Inc.
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“Three Weeks of Occlusion Training can Improve Strength and Power in Trained Athletes”
by Cook CJ, Kilduff LP, Beaven CM
International Journal of Sports Physiology and Performance
© 2013 Human Kinetics, Inc.
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“Three Weeks of Occlusion Training can Improve Strength and Power in Trained Athletes”
by Cook CJ, Kilduff LP, Beaven CM
International Journal of Sports Physiology and Performance
© 2013 Human Kinetics, Inc.
Figure One: Adaptive Responses within a Rugby Pre-season Training Block with or without
Occlusion.
Solid line: 180 mmHg occlusion applied to the lower-limbs during exercise; Dotted line: No
occlusion stimulus applied during training. 1-RM: One-Repetition Maximum; CMJ:
Countermovement Jump; ** p< 0.01; * p< 0.05. Pre: Data collected before the 3-week
training block; Post: Data collected after the 3-week training block. Error bars represent
standard deviations.
“Three Weeks of Occlusion Training can Improve Strength and Power in Trained Athletes”
by Cook CJ, Kilduff LP, Beaven CM
International Journal of Sports Physiology and Performance
© 2013 Human Kinetics, Inc.
Figure Two: Salivary Hormone Responses to Selected Sessions within a Rugby pre-season
Training Block with or without Occlusion.
Solid bar: 180 mmHg occlusion applied to the lower-limbs during exercise; White bar: No
occlusion stimulus applied during training. Percent change: Change in salivary hormone
concentrations from data collected before one training session to data collected after the same
training session. ** p< 0.01. Error bars represent standard deviations.
“Three Weeks of Occlusion Training can Improve Strength and Power in Trained Athletes”
by Cook CJ, Kilduff LP, Beaven CM
International Journal of Sports Physiology and Performance
© 2013 Human Kinetics, Inc.
Table 1. Physical Characteristics of the Athletes (mean ± SD)
Group 1
(n= 10)
Group 2
(n= 10)
Age (yr)
21.8 ± 1.2
21.1 ± 1.5
Height (cm)
1.84 ± 0.05
1.84 ± 0.06
Body Mass (kg)
94.7 ± 10.3
96.4 ± 11.0
Bench Press Strength (kg)
139.0 ± 7.8
141.0 ± 13.6
Leg Squat Strength (kg)
171.5 ± 11.9
174.8 ± 13.6
40 m sprint time (s)
5.08 ± 0.18
5.11 ± 0.18
Performance Maintenance (%)
93.1 ± 2.0
92.2 ± 1.8
CMJ Peak Power (W)
5216 ± 1027
5551 ± 932
CMJ: Countermovement Jump; Performance Maintenance: change in sprint speed from the
first to last of 5 x 40 m sprints [(Sprint #1/Sprint #5)*100] with 1 min recovery time between
sprints.
... Generally, previous research has examined BFR in conjunction with low intensity aerobic and resistance training, whereas few studies have used BFR with higher-load training ( Laurentino et al., 2008;Keramidas et al., 2012;Cook et al., 2014;Paton et al., 2017), and the results were somewhat contradictory. Studies by Keramidas et al. (2012) and Laurentino et al. (2008) reported no added benefit on VO 2 max ( Keramidas et al., 2012) and muscle strength ( Laurentino et al., 2008), respectively following 6-8 weeks of intense training. ...
... Studies by Keramidas et al. (2012) and Laurentino et al. (2008) reported no added benefit on VO 2 max ( Keramidas et al., 2012) and muscle strength ( Laurentino et al., 2008), respectively following 6-8 weeks of intense training. In contrast, Cook et al. (2014) reported greater improvements in muscle strength compared with non-occluded controls following 3 weeks of strength training (Cook et al., 2014) and Paton et al. (2017) reported significant improvements in running economy and time to exhaustion in a BFR trained group relative to a non-BFR group ( Paton et al., 2017) following four weeks of running training. The gained further improvements following adding BFR were ascribed to more muscular adaptation ( Paton et al., 2017). ...
... Studies by Keramidas et al. (2012) and Laurentino et al. (2008) reported no added benefit on VO 2 max ( Keramidas et al., 2012) and muscle strength ( Laurentino et al., 2008), respectively following 6-8 weeks of intense training. In contrast, Cook et al. (2014) reported greater improvements in muscle strength compared with non-occluded controls following 3 weeks of strength training (Cook et al., 2014) and Paton et al. (2017) reported significant improvements in running economy and time to exhaustion in a BFR trained group relative to a non-BFR group ( Paton et al., 2017) following four weeks of running training. The gained further improvements following adding BFR were ascribed to more muscular adaptation ( Paton et al., 2017). ...
Article
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The aim of this study was to investigate the effect of leg blood flow restriction (BFR) applied during a 3-a-side futsal game on strength-related parameters. Twelve male futsal players were randomly assigned into two groups (n=6 for each group) during 10 training sessions either with or without leg BFR. Prior to and post training sessions, participants completed a series of tests to assess anabolic hormones and leg strength. Pneumatic cuffs were initially inflated to 110% of systolic blood pressure and further increased by 10% after every two completed sessions. In comparison with baseline, the resting post-training levels of myostatin (p=0.002) and IGF-1/MSTN ratio (p=0.006) in the BFR group changed, whereas no change in the acute level of IGF-1 and myostatin after exercise was observed. Peak torque of knee extension and flexion increased in both groups (p<0.05). A trend of increased neural activation of all heads of the quadriceps was observed in both groups; however, it was statistically significant only for rectus femoris in BFR (p=0.02). These findings indicated that the addition of BFR to normal futsal training might induce greater neuromuscular benefits by increasing muscle activation and augmenting the hormonal response.
... In addition, the gains observed following BFR resistance training have been shown to be similar to traditional heavy-load resistance training (HLRT) , Karabulut et al., 2011a, Laurentino et al., 2012, Takarada et al., 2000c. This relatively unique mode of resistance training has been shown to produce significant gains in muscle strength and mass in young healthy untrained populations (Abe et al., 2005c, Yasuda et al., 2010b, trained athletes (Cook et al., 2013, Abe et al., 2005b, and perhaps of more importance, has been shown to be beneficial for clinical populations with limited resistance training capacities such as the elderly (Ozaki et al., 2011a, Fry et al., 2010, Takarada et al., 2000c, Sakamaki et al., 2008, patients in early rehabilitation following injury (Loenneke et al., 2012g, Ohta et al., 2003, Takarada et al., 2000b, or where muscle atrophy and weakness occur due to the effects of inactivity or disease (Cook et al., 2010, Cook et al., 2014. As such, a greater understanding of the physiological responses and adaptations following BFR resistance exercise (BFR-RE) and resistance training (BFR-RT) should be of interest. ...
... However, BFR-RT studies have used a range of exercise intensities from 15% MVIC (Kacin and Strazar, 2011) to approximately ~80% 1-RM (Laurentino et al., 2008, Cook et al., 2013. Overall, the majority of protocols utilize an exercise load equal to 20% 1-RM (Sumide et al., 2009, Cook et al., 2007, Yasuda et al., 2005, Moritani et al., 1992, Kubo et al., 2006, Pierce et al., 2006, Wernbom et al., 2006, Karabulut et al., 2010b, Abe et al., 2005b and some using 30% 1-RM (Madarame et al., 2008, Yasuda et al., 2006, Yasuda et al., 2010c, Loenneke et al., 2010a, Madarame et al., 2010a, Yasuda et al., 2010b) as a means of increasing muscle strength and mass. ...
... 1-RM (Laurentino et al., 2008) provided no additional benefit to muscle strength or mass in comparison with non-BFR-RT at the same intensity. In contrast, Cook et al., (2013) found greater improvements in 1-RM strength for bench press and squat, sprint times, and countermovement jump height following three weeks of training at 70% 1-RM with BFR, compared with controls that trained with the same loads without BFR. ...
Thesis
Full-text available
This thesis provides evidence of central nervous system adaptations as well as reduced exercising haemodynamics and perceptual responses when light-load resistance exercise/training is performed with blood flow restriction. In addition, this type of training appears beneficial in order to target gains in strength and muscle mass in healthy young populations.
... Research recommends that a hypertrophy microcycle should involve lifting at a minimum of 65% of an athlete's maximal strength capacity (1 RM) (Loenneke & Pujol, 2009), and should last between four and six weeks to allow for neuromuscular and physiological adaptation to the training stimulus (Loenneke, Wilson & Wilson, 2010). However, this level of training stress is often undesirable, and the duration unobtainable, during a competitive season (Cook, Kilduff & Beaven, 2013). This results in an intense pre-season loading period during which the athlete may be at enhanced risk of injury or over-training, or suffer atrophy-induced strength decrements during the competitive season. ...
... This has resulted in suggestions that liBFR should primarily be used as a tool for rehabilitating athletes following injury to help avoid atrophy (Lejkowski & Pajaczkowski, 2011), whilst HIT is used to maintain lean muscle mass and strength during the competitive season. Few studies to date have researched the effects of BFR training with loads and repetitions similar to those used in HIT, however initial results from available literature suggest that maximal strength, power and lean muscle mass can be significantly improved in HIT with the restriction of blood flow (Cook, Kilduff & Beaven, 2013). Whilst this is encouraging, further research is required to assess the extent of EIMD resulting from hiBFR training, as the potential of exaggerated muscle damage alongside neuromuscular deficits (Khamwong, Pirunsan & Paungmali, 2010) would likely discourage its practice as an in-season strength maintenance or hypertrophy tool. ...
... However, further research is still required in order to produce reliable advice as to the most effective combination of exercises, repetitions, sets, intensity and occlusion tourniquet pressure required to obtain optimal results (Cook, Clark & Ploutz-Snyder, 2007, Karabulut & Perez, 2013), as methodological differences are commonplace between BFR studies (Table 1.). (Takarada, Sato & Ishii, 2002), maximal strength ( Cook, Kilduff & Beaven, 2013; Abe, Kearns & Sato, 2006) and muscular endurance (Nakajima et al, 2010). These results are often the primary aims of an athletic training program and achieved through the application of overloading stresses such as resistance exercise ...
Thesis
Full-text available
The exercise induced muscle damage effects of high intensity resistance exercise combined with vascular blood flow restriction were investigated in trained male participants. A cross-over study compared the resulting effects upon DOMS, swelling and ROM following five sets of five unilateral arm curls, using a predetermined 5 RM. Separated by one week, participants completed the protocol once without an occlusive stimulus (CON, n=9) and once with an occlusive tourniquet pressure of 130 mm Hg applied to the upper arm (BFR, n=9). Measurements were taken immediately post-exercise and then one, 24 and 48 hours later, and compared to the pre-exercise values. No significant difference between the BFR and CON groups for any of the EIMD measures were found (p>0.05). Additionally no significant group  time interaction was displayed at any time point following the exercise (p>0.05). The results indicate that intermittently restricting venous blood flow during high intensity resistance exercise does not enhance the resulting levels of performance-affecting muscle damage, and the time course for recovery between the two modalities remains similar. It was therefore concluded that high intensity exercise with blood flow restriction appears to be a safe alternative to normal high intensity resistance training.
... Одним из резервов повышения спортивных резуль- татов юных квалифицированных спортсменок является оптимальное построение подготовки, осуществляемое специалистами на основе современных научных знаний и большого практического опыта работы [3,4,8]. Вместе с тем проблема построения тренировочного процесса квалифицированных спортсменок 16-18 лет на этапе специализированной базовой подготовки не получила достаточного научного обоснования особенно с учетом различий по морфофункциональным показателям и группам весовых категорий [5,11,16,21]. Поэтому поиск эффективных средств и методов построения трениро- вочного процесса для квалифицированных тяжелоат- леток ведущих спортивных школ Украины на основе динамики значимых компонентов физической подготов- ленности в годичном цикле является актуальной проб- лемой для развития резервного спорта в Украине. ...
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... More recently, Manimmanakorn et al. [29] observed that the CSA of knee extensors and flexors increased by 6.6 ± 4.5 % (mean ± SD) following 5 weeks of low-intensity (20 % 1RM) BFR training in netball athletes, whereas the CSA increased by 2.9 ± 2.7 % in the control group. While many of these investigations recruited participants with little or unspecified resistance training experience, recent research indicates that BFR exercise may also be beneficial for resistance-trained athletic populations [30][31][32]. Lowintensity (20 % 1RM) resistance exercise combined with BFR has resulted in greater hypertrophy than in nonrestricted control groups in track and field athletes [30], and American football players [31]. As these participants already have achieved a high level of muscular adaptation to resistance training, low-intensity resistance training would not normally have facilitated hypertrophic gains. ...
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It is generally believed that optimal hypertrophic and strength gains are induced through moderate- or high-intensity resistance training, equivalent to at least 60 % of an individual's 1-repetition maximum (1RM). However, recent evidence suggests that similar adaptations are facilitated when low-intensity resistance exercise (~20-50 % 1RM) is combined with blood flow restriction (BFR) to the working muscles. Although the mechanisms underpinning these responses are not yet firmly established, it appears that localized hypoxia created by BFR may provide an anabolic stimulus by enhancing the metabolic and endocrine response, and increase cellular swelling and signalling function following resistance exercise. Moreover, BFR has also been demonstrated to increase type II muscle fibre recruitment during exercise. However, inappropriate implementation of BFR can result in detrimental effects, including petechial haemorrhage and dizziness. Furthermore, as BFR is limited to the limbs, the muscles of the trunk are unable to be trained under localized hypoxia. More recently, the use of systemic hypoxia via hypoxic chambers and devices has been investigated as a novel way to stimulate similar physiological responses to resistance training as BFR techniques. While little evidence is available, reports indicate that beneficial adaptations, similar to those induced by BFR, are possible using these methods. The use of systemic hypoxia allows large groups to train concurrently within a hypoxic chamber using multi-joint exercises. However, further scientific research is required to fully understand the mechanisms that cause augmented muscular changes during resistance exercise with a localized or systemic hypoxic stimulus.
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