ArticlePDF Available

The Effects of a 7-Week Practical Blood Flow Restriction Program on Well-Trained Collegiate Athletes


Abstract and Figures

The purpose of this study was to examine the effects of a seven-week, practical blood flow restriction (BFR) protocol used in conjunction with a strength training program on measures of muscular strength and size in collegiate American football players. Sixty-two participants were divided into four groups. Three groups completed a traditional upper- and lower-body split strength program. Two of these groups also completed supplemental lifting sessions. Of these two, one completed the additional lifts with blood flow restriction. The final group completed a modified training program, followed by the supplemental lifts, with blood flow restriction. The supplemental lifting protocol consisted of bench press and squat, utilizing 20% 1RM for four sets with 30 repetitions performed in the first set and 20 repetitions performed in the following three. Each set was separated by 45 seconds of rest. The supplemental bench press was completed at the end of upper-body days, and the squat at the end of lower-body days. Dependent measures were taken prior to the start of the program and again upon conclusion: upper- and lower-body girths, 1RM bench and squat. Results of a 4 X 2 mixed model MANCOVA revealed a significant difference for the interaction on the dependent variables. Follow-up univariate ANOVAs indicated a significant difference for 1RM squat. This suggests that a practical BFR program used in addition to a traditional strength training program can be effective at increasing 1RM squat performance. The use of elastic knee wraps makes BFR a feasible training option for coaches and athletes.
Content may be subject to copyright.
Department of Health, Physical Education, and Recreation, Emporia State University, Emporia, Kansas; and
Department of
Health, Sport and Exercise Sciences, University of Kansas, Lawrence, Kansas
Luebbers, PE, Fry, AC, Kriley, LM, and Butler, MS. The effects of
a 7-week practical blood flow restriction program on well-trained
collegiate athletes. J Strength Cond Res 28(8): 2270–2280,
2014—The purpose of this study was to examine the effects of
a 7-week practical blood flow restriction (BFR) protocol used in
conjunction with a strength training program on measures of mus-
cular strength and size in collegiate American football players.
Sixty-two participants were divided into 4 groups. Three groups
completed a traditional upper- and lower-body split strength pro-
gram. Two of these groups also completed supplemental lifting
sessions. Of these 2, 1 completed the additional lifts with BFR.
The final group completed a modified training program, followed
by the supplemental lifts, with BFR. The supplemental lifting pro-
tocol consisted of bench press and squat, using 20% 1 repetition
maximum (1RM) for 4 sets with 30 repetitions performed in the
first set and 20 repetitions performed in the following 3 sets. Each
set was separated by 45 seconds of rest. The supplemental bench
press was completed at the end of upper-body days and the squat
at the end of lower-body days. Dependent measures were taken
before the start of the program and again on conclusion the fol-
lowing dependent variables were measured: upper- and lower-
body girths, 1RM bench, and squat. Results of a 4 32mixed-
model multivariate analysis of covariance revealed a significant
difference for the interaction on the dependent variables. Follow-
up univariate analysis of variances indicated a significant difference
for 1RM squat. This suggests that a practical BFR program used in
addition to a traditional strength training program can be effective at
increasing 1RM squat performance. The use of elastic knee wraps
makes BFR a feasible training option for coaches and athletes.
KEY WORDS KAATSU, occlusion, strength training,
Resistance training has many known athletic bene-
fits, including reducing the risk ofinjury, enhancing
muscular endurance, improving power, promoting
speed development, and increasing muscular
strength. Although many forms of resistance training exist,
weight training has long been a staple among coaches and
athletes for eliciting improvements in muscular fitness.
Traditional weight training program design calls for the
utilization of light weight and high repetitions for increasing
muscular endurance (e.g., ,60% 1 repetition maximum
[1RM] for multiple sets of 10 or more repetitions), whereas
increases in muscular size and strength are generally pursued
with the use of heavy weight and a low number of repeti-
tions (e.g., .70% 1RM for several sets of 6 repetitions or less)
(1,6,11). However, present-day research has demonstrated
that weight training with light weight and high repetitions
can result in significant increases in muscle size and strength
when it is used in conjunction with blood flow restriction
(BFR). These observations have been made in healthy,
untrained, and recreationally trained participants (2,31,32,39)
and in athletic populations (3,30,36).
Blood flow restriction training (also known as occlusion
training) is the act of reducing the amount of arterial blood
flow to the working muscles while occluding venous return
(8,25). This is achieved by placing a wrapping device around
the proximal end of the muscles in which the restriction is
desired. The resultant decreased delivery and cessation of
return is believed to be responsible for many of the proposed
mechanisms for the efficacy of BFR training in promoting
muscular strength and hypertrophy. The most prevalent the-
ories stem from the reduced oxygen availability and metab-
olite accumulation in the affected muscles. This low-oxygen
high-metabolite environment has been demonstrated to
increase the recruitment of high-threshold motor units
(31,37), which are typically only recruited under heaving
loading conditions (14,28). In addition, some research has
indicated that there can be an exaggerated growth hormone
release after BFR training (10,27,29), although the role
played by systemic growth hormone in hypertrophy has
been challenged in recent years (34).
Address correspondence to Paul E. Luebbers,
Journal of Strength and Conditioning Research
Ó2014 National Strength and Conditioning Association
Journal of Strength and Conditioning Research
Copyright © National Strength and Conditioning Association Unauthorized reproduction of this article is prohibited.
However, these mechanisms cannot account for some
circumstances in which BFR has been shown to be
beneficial, as much of the BFR research uses modalities
other than resistance training. In 2000, Takarada demon-
strated that static BFR was effective in attenuation of muscle
loss in bedridden patients recovering from anterior cruciate
ligament surgery. Being nonambulatory negates the recruit-
ment of any muscle fiber type, and metabolic build-up is
negligible. A similar study conducted by Kubota in 2008 also
demonstrated an offsetting of thigh muscle atrophy in
movement-restricted participants receiving a BFR treatment
(16). Abe et al. (4) observed increased muscular strength and
hypertrophy by using BFR in combination with slow tread-
mill walking. Although Abe did not measure metabolites,
Loenneke et al. (23) conducted comparable research in
which lactate was assessed. Analysis revealed that slow
treadmill walking using BFR did not result in metabolite
accumulation. So, although increased motor unit recruit-
ment and metabolite build-up may play a role in the positive
muscular adaptations seen with BFR training, it is apparent
that there are other mechanisms involved.
Loenneke et al. (18,20) have theorized that muscle cell
swelling may be an important factor. The decreased arterial
delivery and cessation of venous return during a BFR appli-
cation lead to a pooling of blood in the muscles distal to the
application site of occlusion. This pooling effect could cause
a shift in intra- and extracellular fluids leading to an increase
in muscle cell volume. Haussinger et al. (12) first theorized
that cell swelling may induce an anabolic response, and
follow-up work supports the concept (7,15). This mecha-
nism may explain why BFR seems to attenuate muscle atro-
phy during times of immobilization where there is an
absence of exercise and/or metabolite accumulation. It
would appear that this may be the 1 consistent factor across
all modalities of BFR training.
To obtain BFR, most research studies have used pneu-
matic wrapping devices, such as a KAATSU Master (Sato
Sports Plaza Ltd., Tokyo, Japan), or modified blood pressure
cuffs, which allow for precise control of the amount of
applied pressure. Although pneumatic devices allow for
control of the pressure during BFR training, generally, they
are not practical for use outside of a clinical or laboratory
situation because of being cost prohibitive and/or limited in
accessibility. In 2009, Loenneke and Pujol (22) proposed the
use of elastic knee wraps for BFR training (i.e., practical
BFR), which would make the method a feasible option for
general use. Quantification of the pressure exerted by a taut
elastic wrap in a real-world setting is not possible; therefore,
it was suggested that pulling the wraps tight to a moderate
perceptive pressure (e.g., a 7 on a scale of 0 to 10) would be
sufficient. This protocol has since been shown to be effective
in occluding venous return while sufficiently reducing arte-
rial delivery (35).
It is clear that the literature supports the efficacy of BFR
training for promoting positive muscular adaptations across
a variety of populations and modalities. However, few
studies have used elastic knee wraps (17,21,23,24,36), and
even fewer have used them outside of a laboratory setting
with an athletic population (36). Additional research in this
area will provide further insight into the use of practical BFR
in those who are already well trained.
The purpose of this study was to examine the effects of
a 7-week practical BFR protocol used in conjunction with
a traditional weight training program on measures of
muscular strength and size in collegiate American football
players. The protocol used in this investigation was modeled
after a practical BFR study conducted by Yamanaka et al.
(36), which also used an American football team. This study
was a field experiment conducted during the team’s off-
season, as a part of their strength and conditioning program.
It was hypothesized that those who completed the tradi-
tional training program, in combination with the supplemen-
tal lifting protocols, under conditions of practical occlusion
would experience greater gains in muscular strength and size
than those in the other treatment groups.
Experimental Approach to the Problem
This investigation employed a pretest-posttest mixed model
design with a training intervention. Participants were re-
cruited from a National Collegiate Athletic Association
(NCAA) Division II American football team, from which
72 players volunteered to take part. All participants com-
pleted a 7-week off-season football strength and condition-
ing program. Before the start of the program, and again on
conclusion, the following dependent variables were mea-
sured: upper- and lower-body girths, and strength as
determined by 1RM bench press and squat.
There were 4 groups of participants in this study. The
football coaching staff was aware that the experimental
design called for one of the group’s training program to be
modified in such a way that its members would not com-
plete any high-intensity lifting. They expressed concern
about restricting players who held the traditional strength
and power positions (linemen and linebackers) from high-
intensity work. Their concern was addressed by removing
those positions from the initial selection pool and forming
the modified group (M/S/R) from the remaining subset of
players. Once the modified group was established, the line-
men and linebackers were returned to the selection pool
with the other remaining players and randomly assigned
among the other 3 groups (H/S/R, H/S, and H). For a com-
plete description of these groups, see Training Protocols and
The football program was a part of the Intercollegiate
Athletics Department at a midwestern regional university.
Permission to conduct the study was granted by the
university’s institutional review board. The coaching staff
Journal of Strength and Conditioning Research
VOLUME 28 | NUMBER 8 | AUGUST 2014 | 2271
Copyright © National Strength and Conditioning Association Unauthorized reproduction of this article is prohibited.
of the football team agreed to the recruitment of participants
from the team and allowing the necessary modifications to
be made to the strength and conditioning program. Details
of the study were verbally explained to the entire team by
the principal investigator at a team meeting. Seventy-two
team members volunteered to be participants. Each partici-
pant signed an informed consent document. All were
deemed healthy and able to train by the university’s medical
and athletic training staff.
The off-season training program took place during an
academic semester and lasted for 7 weeks, with 4 training
days each week—2 upper-body days and 2 lower-body days.
Players were assigned by their coaches to attend 1 of 3
training sessions each day, based on their class schedules.
Training sessions were held at 7:15 AM, 1:30 PM, and 3:30 PM.
The study began with 72 participants (18 in each group).
Because of non-BFR related injuries or lack of compliance
with the protocol, 10 players were removed from the study.
Complete data were collected on the 62 remaining partic-
ipants (20.3 61.1 year old, 99.1 619.7 kg, and 7.1 62.2
years of weight training experience).
Pretests and Posttests. All participants attended pretest and
posttest sessions for assessment of dependent variables. Both
the pretests and posttests were split between 2 days. Pretest
Day 1 was comprised of upper- and lower-body girths and
1RM bench press. Body mass was measured for descriptive
and statistical purposes. This session was completed after 48
hours of rest. Pretest Day 2 followed the next day and
consisted of the 1RM squat test. The same measures were
again taken at the posttest sessions, which were completed at
the conclusion of the program. Posttest day 1 took place after
48 hours of rest, followed by posttest day 2, taking place the
very next day. All pretests and posttests took place during the
participants’ regular training session time. Figure 1 provides
a schematic of the testing and training sessions.
Body Mass and Girths. Body mass was measured with a Tanita
WB-3000plus Digital Physicians Scale (Arlington Heights,
IL, USA). The American College of Sports Medicine
protocols for measuring circumferences were used for
assessing arm and thigh girths (13). Chest girth was deter-
mined by placing the tape horizontally around the torso at
the level of the nipple, and measurement was taken at the
end of normal exhalation. All measurements, both pre and
post, were assessed using a Gulick tape measure and were
taken by the same investigator, whose test-retest reliability
was 0.55% coefficient of variation (CV) for the arm, 0.47%
CV for the thigh, and 0.48% CV for the chest.
1 Repetition Maximum Tests. Maximal strength for bench
press and squat were assessed following procedures set forth
by the football coaching staff. Players completed 1 warm-up
set of 10 repetitions using approximately 40% of their
estimated 1RM and a second warm-up set of 5 repetitions
using approximately 60% of their estimated max. After
adequate rest, players loaded the bar with approximately
80–85% of their estimated 1RM and completed 1 repetition.
Weight was added with each subsequent 1 repetition set
until the player could no longer complete a repetition cor-
rectly. The 1RM was determined as the last weight used in
which the participant successfully completed the lift with
proper form through the entire range of motion, as defined
by National Strength and Conditioning Association (NSCA)
(5). Conditions between the pre- and posttest 1RMs were made
as identical as possible (see discussion above and Figure 1).
Wearing a weightlifting belt was encouraged, but not required.
Figure 1. Testing and training schematic.
Practical Blood Flow Restriction
Journal of Strength and Conditioning Research
Copyright © National Strength and Conditioning Association Unauthorized reproduction of this article is prohibited.
Players who chose to wear a belt for a pretest 1RM also wore
chose not to wear a belt. All 1RM tests, both pre and post, were
supervised by the same members of our research team, each of
whom is a NSCA Certified Strength and Conditioning Special-
ist (CSCS). Test-retest reliability as determined by our research
team for the 1RM bench press was 0.62% CVand 0.35% CV for
the 1RM squat.
Training Protocols and Groups
Each of the 4 groups completed a different training protocol
and/or training intervention, an overview of which can be
found in Table 1. Details of each can be found below and
examples can be found in Tables 2 and 3.
Traditional High-Intensity Training Program (H). In brief, this
was a weightlifting program focused largely on increasing
strength. It used sets, repetitions, and loading schemes
of traditional high-intensity programs (i.e., multiple low-
repetition sets with high %1RM). While the intricacies of the
program changed over the course of the 7 weeks, at its
foundation were lifts traditionally used in American football
programs: bench press, overhead press, power cleans, squats,
and variations of each. Auxiliary lifts, such as bicep curls,
triceps extensions, calf raises, and abdominal work were also
included. Training was split into alternating upper- and
lower-body days, each being trained twice per week,
although not always in the same sequence. There were 4
training days per week, occurring on Mondays, Tuesdays,
Thursdays, and Fridays. Tables 2 and 3 provide representa-
tive workouts for lower- and upper-body days. The program
followed this lifting format for the duration of the 7-week
Modified Training Program (M). This protocol was identical to
the traditional training program, with the exception that
high-intensity bench press, squat, and their variations were
excluded (Tables 2 and 3).
TABLE 1. Groups, training programs, and protocols.*
Modified program
Traditional high-intensity
program (H)
Supplemental 20% 1RM
protocol (S)
Blood flow restriction
H/S/R ✓✓
H/S ✓✓
M/S/R ✓✓
*1RM = 1 repetition maximum.
TABLE 2. Representative lower-body day for each group: Total volume-load.*
Exercise Set Rep Load (kg)
Vol-load Vol-load Vol-load Vol-load
Squat 1 8 130 (65%) 1,040 1,040 1,040
1 6 140 (70%) 840 840 840
1 4 160 (80%) 640 640 640
1 2 170 (85%) 340 340 340
1 2 180 (90%) 360 360 360
Lateral squats 3 5 130 (65%) 1,950 1,950 1,950
Good mornings 3 6 45.5 819 819 819 819
DB lunges3 8 22.7 544.8 544.8 544.8 544.8
Glute-Ham raises 3 6 11.4 205.2 205.2 205.2 205.2
Supplemental squats 1 30 40 (20%) 1,200 1,200 1,200
3 20 40 (20%) 2,400 2,400 2,400
Total vol-load (kg) 10,339 10,339 6,739 5,169
*Participants with a 200 kg 1RM squat.
DB = dumbbell.
Journal of Strength and Conditioning Research
VOLUME 28 | NUMBER 8 | AUGUST 2014 | 2273
Copyright © National Strength and Conditioning Association Unauthorized reproduction of this article is prohibited.
Supplemental 20% 1 Repetition Maximum Lifting Protocol (S).
Participants completed these sessions together, at the same
time, at the conclusion of their training workouts. All
sessions were supervised by the same 2 primary researchers
to ensure compliance. The supplemental squats were
performed at the end of lower-body training days, and the
supplemental bench press was performed at the end of upper-
body days. Barbell load was set at 20% of pretest 1RM. A list
of each participant’s barbell load was posted at each lifting
station to ensure correct loads were used. Players completed
1 set of 30 repetitions followed by 3 sets of 20 repetitions, with
45 seconds of rest between each set (Tables 2 and 3). The
pace of the concentric and eccentric phases of each repetition
was set at 1.5:1.5 seconds. This cadence was guided by a series
of ascending and descending tones that were played through
the weight room’s stereo system from a prerecorded .mp3 file.
All 4 sets, including the rest periods, were incorporated into
the .mp3 file and verbal instructions for the sessions. This
provided consistency between all sessions throughout the
duration of the program and allowed for the investigators to
closely monitor the participants for compliance.
Practical Blood Flow Restriction (R). Restriction of blood flow
in the participants receiving the occlusion treatment was
accomplished with the use of powerlifting elastic knee wraps
with hook-and-loop closure (Grizzly Fitness, Kitchener, ON,
Canada). The wrap dimensions were 7.6 3167.6 cm (3.0 3
66.0 in) and were graduated every 1.3 cm (0.5 in) perpen-
dicular to the edge with a silver permanent marker. For the
BFR bench press, the wraps were applied to the proximal end
of the upper extremities (above the bicep, below the deltoid).
For the BFR squat, the wraps were applied at proximal end of
the lower extremities (at the top of thigh, near the inguinal
crease). The wraps were initially applied without tension, but
secure enough to remain in place. Just before the start of the
lifting session, the wraps were pulled to a 7.6 cm (3.0 in)
overlap as measured by the silver markings and secured. This
tension was maintained for the entire 4-set lifting session,
including the rest periods. The wraps were removed immedi-
ately at the conclusion of the lifting sessions.
H/S/R Group. This group completed the traditional high-
intensity training program (H) and the supplemental 1RM
lifting protocols (S). They did so with the wraps in place,
under conditions of practical BFR (R).
H/S Group. This group completed the traditional high-
intensity training program (H) and the supplemental 1RM
lifting protocols (S). However, they did not use the wraps;
therefore, they did not receive the BFR treatment.
H Group. This group completed only the traditional high-
intensity training program (H). They did not participate in
the supplemental lifting sessions and at no time did they use
the wraps.
M/S/R Group. This group completed the Modified Training
Program (M). At the end of these sessions, they also
completed the supplemental 1RM lifting sessions (S) and
did so under conditions of practical BFR (R).
Training Sessions. To accommodate players’ class schedules,
the athletes were assigned by their coaches to attend 1 of the
3 training sessions each day. Training sessions were held at
7:15 AM, 1:30 PM, and 3:30 PM. Members of each training
group were present during all training sessions.
TABLE 3. Representative upper-body day for each group: Total volume-load.*
Exercise Set Rep Load (kg)
Vol-load Vol-load Vol-load Vol-load
Bench press 1 8 81 (65%) 650 650 650
1 6 87.5 (70%) 525 525 525
1 4 100 (80%) 400 400 400
1 2 106.25 (85%) 215 215 215
1 2 112.5 (90%) 225 225 225
Lockout press 4 2 81 (65%) 650 650 650
Upright rows 3 6 45 810 810 810 810
Single-arm DBrows 3 8 45.5 1,092 1,092 1,092 1,092
Tricep DB extensions 3 10 25 750 750 750 750
DB hammer curls 3 10 22.7 681 681 681 681
Supplemental bench 1 30 25 (20%) 750 750 750
3 20 25 (20%) 1,500 1,500 1,500
Total vol-load (kg) 8,248 8,248 5,998 5,583
*Participants with a 125 kg 1RM bench press.
DB = dumbbell.
Practical Blood Flow Restriction
Journal of Strength and Conditioning Research
Copyright © National Strength and Conditioning Association Unauthorized reproduction of this article is prohibited.
Participants did not wear knee or elbow wraps during the
workout sessions. In addition, they were instructed to refrain
from any resistance training outside of football practice for
the duration of the study.
Statistical Analyses
A432 mixed-model multivariate analysis of covariance
(MANCOVA), with training groups serving as the
between-factor, pre- and posttests as the within-factor, and
body mass as the covariate was performed using PASW
Statistics 18. The level of significance was set at 0.05. Sepa-
rate univariate 1 34 analysis of variance (ANOVA) tests
were conducted on each dependent variable as a follow-up
test for any significant main effects from the MANCOVA.
The univariate follow-up ANOVA tests were also mixed
model with training groups serving as the between-factor
and pre- and posttests as the within-factor. Post hoc tests
were conducted to examine any significant effects from the
univariate ANOVAs.
The means and SDs are listed in Table 4. MANCOVA results
revealed a significant difference for the interaction on the
dependent variables, Wilks’ L= 0.606, F(15, 146.711) =
1.943, p= 0.023, multivariate ή
= 0.154. To follow-up the
significant MANCOVA on the interaction, separate univari-
ate ANOVAs were conducted on each of the 5 dependent
variables. Only one of the follow-up ANOVAs showed a sig-
nificant effect. A significant interaction was found for 1RM
squat, F(3, 57) = 6.460, p= 0.001, ή
= 0.254 (Figure 2). To
help interpret the interaction, a 1-way ANOVA was com-
puted on the change scores for the 1RM squat. This
ANOVA showed a significant difference between groups,
F(3, 58) = 6.00, p= 0.001. Results of Fisher LSD post hoc
tests revealed that the H/S/R group experienced greater
gains in 1RM squat performance than did the M/S/R group
(p,0.000), the H/S group (p= 0.025), and the H group
(p= 0.009).
MANCOVA results revealed no significant difference
for the group factor on the dependent variables, Wilks’
L= 0.75, F
(15, 146.711)
= 1.10, p= 0.360, multivariate ή
0.093. MANCOVA results also revealed no significant differ-
ence for the time factor on the dependent variables, Wilks’
L= 0.830, F
(5, 53)
= 2.172, p= 0.071, multivariate ή
= 0.170.
Because the MANCOVA showed a nonsignificant main
effect for group, follow-up analyses were not required.
However, to better understand
how current results compare to
those of Yamanaka et al. (36),
additional analyses were con-
ducted on 1RM bench press
performance and circumfer-
ence measures.
For 1RM bench press, depen-
dent t-tests were run to examine
changes from pre- to posttest
for the dependent variables,
and a 1 34 ANOVA was con-
ducted on change scores, which
is a comparable analysis to the
independent t-tests performed
by Yamanaka et al. on percent
change. Although the t-test on
1RM bench revealed that there
was a significant increase across
groups (t
= 6.713, p,
0.000), the ANOVA did not
detect differences between the
groups (F
Dependent t-tests on arm and
thigh circumferences indicated
a significant increase across
groups (arm = t
p= 0.046; thigh = t
p,0.000), but no change for
chest girth (t
0.739). The ANOVA did not
TABLE 4. Girth and strength measures.
Group N
Pretest Posttest
Mean changeMean SD Mean SD
Arm (cm)
H/S/R 17 34.7 3.0 35.3 3.0 0.52
H/S 14 36.3 3.8 36.7 3.7 0.49
H 15 35.6 3.0 36.4 3.1 0.78
M/S/R 16 31.7 1.8 31.6 3.2 20.16
Chest (cm)
H/S/R 17 102.2 10.3 101.7 9.7 20.57
H/S 14 107.1 13.9 106.5 11.4 20.58
H 15 106.5 11.8 107.3 10.6 0.76
M/S/R 16 95.0 3.4 94.9 3.1 20.01
Thigh (cm)
H/S/R 17 59.5 4.7 61.5 3.9 1.98
H/S 14 61.1 5.1 63.1 5.9 2.04
H 15 60.6 6.2 62.9 6.6 2.36
M/S/R 16 55.6 3.3 57.3 2.6 1.71
Bench press (kg)
H/S/R 17 123.3 20.7 132.0 24.4 8.69
H/S 14 135.1 19.7 142.4 19.0 7.3
H 15 137.0 24.4 144.1 25.0 7.12
M/S/R 16 115.2 13.4 117.9 13.5 2.7
Squat (kg)
H/S/R 17 193.2 25.0 218.1 24.6 24.87
H/S 14 196.6 27.6 210.9 26.8 14.13
H 15 197.0 35.1 210.6 38.9 13.64
M/S/R 16 174.4 22.2 180.4 24.9 5.97
Journal of Strength and Conditioning Research
VOLUME 28 | NUMBER 8 | AUGUST 2014 | 2275
Copyright © National Strength and Conditioning Association Unauthorized reproduction of this article is prohibited.
detect differences between groups for any girth measurement
(arm = F
= 0.946, p= 0.424; thigh = F
= 0.102, p=
0.958; chest = F
= 1.043, p= 0.381).
The purpose of this study was to investigate the effects of
a 7-week practical BFR protocol used in conjunction with
traditional weight training on measures of muscular strength
and size in collegiate American football players. We hypoth-
esized that those who supplemented the traditional high-
intensity strength training program with the low-intensity
lifting protocol under conditions of practical occlusion
would experience greater gains in muscular strength and
size than those in the other treatment groups. The results
partially support the hypothesis.
The primary results of this study were as follows: (a)
H/S/R experienced significantly larger increases in 1RM
squat than the other training groups; (b) although there was
a significant increase in 1RM bench press across groups, the
addition of the supplemental lifting protocol, with or without
occlusion, made no difference in the extent of those gains;
(c) although thigh and arm size increased significantly across
groups, the addition of the supplemental lifting protocol,
with or without occlusion, made no difference in the extent
of those increases.
The supplementary low-intensity training protocol used in
this study to examine the BFR treatment was a modification
of that used by Yamanaka et al. (36), who also used a colle-
giate American football team as the testing population. Both
the Yamanaka et al. study and this investigation used a train-
ing load of 20% 1RM with a set and repetition scheme of
1 set of 30 repetitions, followed by 3 sets of 20 repetitions,
with 45 seconds of rest between each set.
The differences were that Yamanaka et al. (36) used a 5.0-
cm wide elastic wrap (manufacturer not reported) and tight-
ened to a 5.1 cm (2.0 in) overlap, whereas we used a 7.6-cm
wide wrap and used a 7.6 cm (3.0 in) overlap to achieve the
BFR. They used a cadence of 2.0:1.0 seconds for pacing the
eccentric and concentric components of each lift, whereas
we used a cadence of 1.5:1.5 seconds, based on work by
Yasuda et al. (38).
Also, they performed both the BFR squat and bench press
on the same day, as their 4-week program completed 3 total-
body workouts per week (36). Our 7-week program used an
upper- and lower-body split routine, with each being per-
formed twice per week, for a total of 4 lifting days per week.
Therefore, the BFR squat and bench press lifts were on
separate days, each following the respective lower-body or
upper-body workouts.
Finally, their study used 2 training groups, both of which
completed the supplementary 20% 1RM lifting sessions,
although only 1 received the practical BFR wrap treatment
(36). We replicated this scenario with our H/S and H/S/R
groups. However, we incorporated 2 additional groups in an
effort to further clarify the potential effects of practical BFR
training in a well-trained population. Yamanaka et al. re-
ported significant differences between groups in 1RM bench
press and squat performance gains, with those in the BFR
treatment group experiencing larger increases. In addition,
they also observed differences in chest size, with the BFR
group again seeing greater increases. The results of this study
only partially replicated the findings of Yamanaka et al.
Yamanaka at al. (36) reported that the BFR treatment
group experienced significantly greater gains in 1RM squat
than those of the non-BFR control group. This investigation
replicated that finding. Univariate follow-up tests to the sig-
nificant interaction showed a significant difference for 1RM
squat, with the H/S/R group experiencing greater gains
than the other training groups (Figure 2).
This disproportionate increase was likely a result of the
use of practical BFR in conjunction with the low-intensity
supplemental lifting protocol at the conclusion of the
traditional high-intensity workout. A brief review of the
training groups aids in understanding this interpretation.
First, M/S/R also performed the supplemental lifts with the
practical occlusion application (i.e., the wraps), but com-
pleted only the modified training program, which excluded
any traditional high-intensity squat variations. This seems to
indicate that performing low-intensity BFR after high-
intensity training results in greater increases than can be
expected when performing BFR in the absence of high-
intensity training. Second, H/S completed the high-intensity
training and the low-intensity supplemental lifts, but not
under conditions of practical occlusion. Therefore, the
occlusion application appears to provide an additional
stimulus for strength gains beyond the low-intensity supple-
mental lifting protocol even when used in conjunction with
high-intensity training. Finally, the gains experienced by
Figure 2. Group 3time interaction for 1 repetition maximum squat. * =
significantly different from the other 3 training groups (p#0.05).
Practical Blood Flow Restriction
Journal of Strength and Conditioning Research
Copyright © National Strength and Conditioning Association Unauthorized reproduction of this article is prohibited.
M/S/R and H/S were the same as those seen by H, who
completed only the traditional high-intensity workout. The
lack of difference among these 3 groups further supports the
concept that the additional gains seen by H/S/R are likely
the result of the combination of high-intensity training
followed by the low-intensity supplemental sessions under
conditions of practical BFR.
As with the 1RM squat, Yamanaka et al. (36) reported
significant increases in 1RM bench press performance, with
the BFR treatment group experiencing greater gains than
the non-BFR control group. This investigation did not sup-
port this finding. Because the MANCOVA showed a nonsig-
nificant main effect for group, follow-up analyses were not
required. But as previously noted, additional analyses were
conducted to better understand how current results compare
to those of the Yamanaka et al. study (see Results). Although
the dependent t-test on 1RM bench revealed that there was
a significant increase across groups, the ANOVA did not
detect differences between groups. This indicates that in
reference to upper-body strength, neither the supplemental
lifting protocol nor practical BFR application provided any
additional benefit beyond what was experienced with the
traditional high-intensity training regimen.
One possible explanation for this is that the upper-body
high-intensity workout had already provided a maximum
stimulus for increasing strength and that the potential gains
often seen with BFR training were attenuated accordingly.
Wernbom et al. (33) noted in their review of resistance train-
ing that there appears to be a sigmoidal dose-response in
reference to training volume, whereas gains in muscle mass
seem to increase with greater volumes or durations of work,
but that there is a point of diminishing returns. They go on
to indicate that moderate volumes of work appear to result
in the largest responses. Although Wernbom et al. are refer-
encing muscle mass and not strength per se, it seems reason-
able that a similar dose-response would exist with strength
gains as strength is a property of the neuromuscular system.
Therefore, it is possible that the volume of the upper-body
high-intensity training protocol was near the peak of the
dose-response curve and that the additional dose provided
by the supplemental training volume and/or the BFR occlu-
sion stimulus could not elicit further response.
Although the high-intensity workout may have provided
sufficient stimulus for strength gains in H, H/S, and H/S/R,
it does not explain the gains experienced by M/S/R, who
only completed the modified training protocol before the
BFR training. It is possible that the BFR application could
account for the strength gains, which has been demonstrated
previously in trained populations (3,30,36). However, in the
absence of a non-BFR, modified training group with which
to compare, it can only be speculated.
Another possibility is that although M/S/R did not
perform any of the traditional “high-intensity” lifts, they still
completed a substantial amount of total work. The overall
volume of BFR training sessions can be quite high even
though BFR training is often described as low-intensity
work. Defining workout intensity by the percentage of the
1RM (%1RM) of a given lift for an individual is common and
is often referred to as relative intensity (9). But, although
BFR training typically uses a low relative intensity of 20–
30% 1RM, the work volume for a session of BFR exercise
can be substantial and possibly comparable to the work vol-
ume of a traditional “high-intensity” session. For example,
a bench press 1RM of 100.0 kg would dictate a barbell load
for a BFR session using 20% 1RM to be 20.0 kg. If the BFR
protocol was identical to that used in this study, a total of 90
repetitions with that load would be performed, resulting in
an exercise volume-load (repetitions 3weight) of 1,800 kg.
If a more traditional high-intensity workload of 80% of that
same 1RM (80.0 kg) were used to complete a typical high-
intensity workout of 4 sets of 6 repetitions, the total exercise
volume-load would be 1,920.0 kg—only 120.0 kg more than
the BFR session. Therefore, it is plausible that the volume-
load completed by M/S/R was high enough on the dose-
response curve that strength gains resulted, despite the
absence of using a high relative intensity.
Although research generally indicates that traditional
high-intensity programs are superior for strength gains,
there is some work that suggests that using a low relative
intensity along with higher repetitions may also be effective
at promoting strength, provided enough volume is used,
even in the absence of BFR (26). However, because total
workloads for each participant were not calculated for this
study, this remains speculative.
The possibility that the upper-body high-intensity training
program alone may have provided a maximal strength gain
stimulus is also supported by observations made during this
study that seem to oppose those made by Yamanaka et al. (36)
in their investigation. They stated that all participants in their
study were able to complete every repetition in the supple-
mental protocols and that personal conversation with the
participants after the sessions indicated that the players felt
that the number of repetitions “was not sufficient for them to
reach exhaustion.” Interestingly, our observations during this
study were quite different. Although no data were collected
on repetitions completed, we observed that some participants
had to pause or skip a repetition during the supplemental
lifting sessions. Personal discussions indicated that these par-
ticipants were simply getting fatigued and needed a brief
respite to continue. Although this was only occasionally seen
during the squat exercise, it was more common during the
bench press sessions. This was true for participants who were
in both H/S and H/S/R (non-wrapped and wrapped), which
indicates that the fatigue could not have been because of the
use of the practical BFR wraps alone.
This is also supported by our observations that those in
M/S/R did not skip repetitions during the sets, even though
they were also using the elastic wraps in the same manner as
H/S/R. Because M/S/R completed only the modified
training program before BFR training (i.e., no high-intensity
Journal of Strength and Conditioning Research
VOLUME 28 | NUMBER 8 | AUGUST 2014 | 2277
Copyright © National Strength and Conditioning Association Unauthorized reproduction of this article is prohibited.
squats, bench press, or their variations), it suggests that the
fatigue experienced by H/S and H/S/R was more likely
a result of the high-intensity training program that they
completed just before the supplemental training, rather than
the extra lifting sessions and/or the BFR wraps. Although
Yamanaka et al. (36) did not report the details of the strength
and conditioning program used in their study, it seems rea-
sonable to surmise that it was of a lower overall volume than
the high-intensity training program used by H, H/S, and H/
S/R in this investigation. The volume of the workout and
BFR training protocol used by Yamanaka et al. may have been
sufficiently low enough on the dose-response curve that the
extra stimulus provided by the BFR wraps was able to pro-
duce an increased response.
In reference to the work volume-load of the lower-body
sessions, H/S/R did experience a greater increase in 1RM
squat compared with H and H/S. This suggests that the high-
intensity lower-body training program did not provide
a maximal stimulus for strength gains. Therefore, the volume
was likely lower on the dose-response curve relative to the
upper-body training, allowing for the addition of the practical
BRF application to elicit a greater strength response.
Similar to Yamanaka et al. (36), this investigation em-
ployed the use of girth measurements in an effort to assess
changes in muscular size, namely at the thigh, chest, and
upper arm. The aforementioned study observed increases
in chest girth but not thigh or arm girth. Thefindings of this
investigation were contrary. As with the 1RM bench press,
the MANCOVA revealed no interaction for group on cir-
cumferences, so additional analyses were conducted to bet-
ter compare current results to those of Yamanaka et al. (see
Results). The dependent t-tests on arm and thigh circum-
ferences indicated a significant increase across groups, but no
change for chest girth. The ANOVA did not detect differ-
ences between groups for any girth measurement. So, while
there was no change in chest size, there were small but
significant increases at the thigh and the arm across groups,
but no differences among the treatments. However, the prac-
tical significance of these results for changes in girths be-
comes questionable when consideration is given to the
magnitude of the changes, as can be seen in Table 4.
This study was not without limitations. Because of using
elastic knee wraps in a practical manner to achieve BFR,
knowing the precise pressure actually applied to each
participant was not possible. Benefits from BFR occur when
there is adequate pressure to occlude venous return, but yet
only restrict arterial delivery (25). Wilson et al. (35) have
shown that elastic wraps (7.6 cm wide) applied with a per-
ceptive pressure of 7 on a scale of 0–10 are effective at
allowing a restricted arterial flow while occluding venous
return in the thigh muscle.
Perceptive pressure is a subjective measure and will likely
differ among individuals and may even vary for each person
on a day-by-day basis. Yamanaka et al. (36) used a 5.1 cm
(2.0 in) overlap to achieve BFR in their study but did not
report on the procedure used to determine that degree of
tension. Before the start of our training program, we re-
cruited 4 athletes in an effort to standardize the elastic wrap
pressure to be used in the study. We explained to them the
concept of the 0–10 scale of perceptive pressure and how to
use it in reference to wrap pressure (35). We then applied
a wrap to the upper leg with just enough tightness to remain
in place (perceptive pressure = zero), and a note was made
of the location of the end of the wrap. Then, the wrap was
slowly pulled tight until the participant indicated that the
tightness had reached a perceptive pressure of 7. The wrap
was then secured in place. The difference between where the
end of the wrap was before the tightening to where it was
secured after the tightening (i.e., the overlap) was measured,
on which the wrap was removed.
This procedure was repeated with every participant and
each required a slightly different overlap to reach a percep-
tive pressure of 7. The overlaps were then averaged, with
a result of approximately 7.0 cm (2.75 in). Following the
same procedure on the arms, we found an average overlap of
approximately 6.6 cm (2.60 in). We concluded that an
overlap of 7.6 cm (3.0 in) for both the upper body and
lower body during the study would likely be sufficient to
obtain a perceptive pressure of 7 for most of the participants
in the study. The use of a single overlap measure for both
applications also simplified the procedures and reduced
potential errors in applying and tightening the wraps.
Another potential limitation is that the participants in this
study were well-trained, male, collegiate American football
players. The results might not be generalizable to other
athletic populations, non-athletes, or those who are weight-
training novices.
Future research should examine high-intensity programs
of various work volumes and their relationship with the
effects of concurrent practical BFR programs. This could
provide additional insight into determining whether a dose-
response does exist when the 2 are used in conjunction and if
so, where the point of diminishing returns can be expected. If
it is found that practical BFR, when used together with
lower volumes of high-intensity work, can elicit strength
gains that are similar to, or exceed those typically observed
with traditional higher volumes of high-intensity work, then
this could have implications for future program design.
A lower overall training volume and/or lower external load
may allow athletes to recover faster, reduce their risk of
injury, and lessen their chance of overtraining. Taken
together with an increase in strength, this could translate
to improved athletic performance.
Investigating the dose-response in the context of in-season
strength and conditioning programs would be especially
relevant as these programs normally reduce volume as focus
shifts from strength training to actual competition. This shift
generally results in athletes experiencing declines in strength
as the season progresses. An effective combination of low
volume, high-intensity work and practical BFR may result in
Practical Blood Flow Restriction
Journal of Strength and Conditioning Research
Copyright © National Strength and Conditioning Association Unauthorized reproduction of this article is prohibited.
the maintenance or increase of strength during the compet-
itive season, which is typically not experienced.
Also, limb size and possibly body composition appear to
play a role in how much pressure is needed to achieve
adequate BFR (19). Therefore, additional research should
examine how to best individualize perceptive pressure when
using practical BFR, for both the lower- and upper-body
In conclusion, this study demonstrated that the use of
a practical BFR program in conjunction with a traditional
high-intensity off-season training program was effective in
increasing 1RM squat performance in well-trained collegiate
The results of this study indicate that practical BFR training
can be effective in increasing 1RM squat performance when
added to an off-season, high-intensity collegiate American
football strength and conditioning program. Elastic power-
lifting knee wraps are relatively affordable and easy to use
compared with traditional BFR methods. This reduction in
the cost and complexity typically associated with BFR
training provides athletic programs, teams, coaches, and
athletes an increased opportunity to incorporate BFR into
their strength and conditioning programs.
The authors would like to thank the Emporia State
University football team and coaching staff for their partic-
ipation and dedication to this study. Also, we would like to
thank the ESU Research and Grants Center and the ESU
Teachers College for their help in funding this project.
1. Ratamess, NA, Alvar, BA, Evetoch, TK, Housh, TJ, Kibler, WB,
Kraemer, WJ, and Triplett, NT. American College of Sports
Medicine position stand. Progression models in resistance training
for healthy adults. Med Sci Sports Exerc 41: 687–708, 2009.
2. Abe, T, Beekley, MD, Hinata, S, Koizumi, K, and Sato, Y. Day-to-
day change in muscle strength and MRI-measured skeletal muscle
size during 7 days KAATSU resistance training: A case study. Int J
KAATSU Train Res 1: 71–76, 2005.
3. Abe, T, Kawamoto, K, Yasuda, T, Kearns, CF, Midorikawa, T, and
Sato, Y. Eight days KAATSU-resistance training improved sprint
but not jump performance in collegiate male track and field athletes.
Int J KAATSU Train Res 1: 19–23, 2005.
4. Abe, T, Kearns, CF, and Sato, Y. Muscle size and strength are
increased following walk training with restricted venous blood flow
from the leg muscle, Kaatsu-walk training. J Appl Physiol (1985) 100:
1460–1466, 2006.
5. Beachle, TR and Earle, RW. Resistance training and spotting
techniques. In: The Essentials of Strength Training and Conditioning.
Baechle and Earle, eds. Champaign, IL: Human Kinetics, 2008.
6. Beachle, TR, Earle, RW, and Wathen, D. Resistance training. In: The
Essentials of Strength Training and Conditioning. Baechle and Earle, eds.
Champaign, IL: Human Kinetics, 2008.
7. Berneis, K, Ninnis, R, Haussinger, D, and Keller, U. Effects of hyper-
and hypoosmolality on whole body protein and glucose kinetics in
humans. Am J Physiol 276: 188–195, 1999.
8. Fahs, CA, Loenneke, JP, Rossow, LM, Thiebuad, RS, and
Bemben, MG. Methodological considerations for blood flow
restricted resistance exercise. J Trainology 1: 14–22, 2012.
9. Fry, AC. The role of resistance exercise intensity on muscle fibre
adaptations. Sports Med 34: 663–679, 2004.
10. Fujita, S, Abe, T, Drummond, MJ, Cadenas, JG, Dreyer, HC, Sato, Y,
Volpi, E, and Rasmussen, BB. Blood flow restriction during low-
intensity resistance exercise increases S6K1 phosphorylation and
muscle protein synthesis. J Appl Physiol (1985) 103: 903–910, 2007.
11. Garber, CE, Blissmer, B, Deschenes, MR, Franklin, BA,
Lamonte, MJ, Lee, IM, Nieman, DC, and Swain, DP. American
College of Sports Medicine position stand. Quantity and quality of
exercise for developing and maintaining cardiorespiratory,
musculoskeletal, and neuromotor fitness in apparently healthy
adults: Guidance for prescribing exercise. Med Sci Sports Exerc 43:
1334–1359, 2011.
12. Haussinger, D, Roth, E, Lang, F, and Gerok, W. Cellular hydration
state: an important determinant of protein catabolism in health and
disease. Lancet 341: 1330–1332, 1993.
13. Arena, R. Health-related physical fitness testing and
interpretation. In: ACSM’s Guidelines for Exercise Testing and
Prescription. Pescatello ArenaRiebeand Thompsoneds. Baltimore, MD:
Lippincott Williams & Wilkins, 2013.
14. Henneman, E. Relation between size of neurons and their
susceptibility to discharge. Science 126: 1345–1347, 1957.
15. Keller, U, Szinnai, G, Bilz, S, and Berneis, K. Effects of changes in
hydration on protein, glucose and lipid metabolism in man: impact
on health. Eur J Clin Nutr 57(Suppl.2): S69–S74, 2003.
16. Kubota, A, Sakuraba, K, Sawaki, K, Sumide, T, and Tamura, Y.
Prevention of disuse muscular weakness by restriction of blood flow.
Med Sci Sports Exerc 40: 529–534, 2008.
17. Loenneke, JP, Balapur, A, Thrower, AD, Barnes, JT, and Pujol, TJ.
The perceptual responses to occluded exercise. Int J Sports Med 32:
181–184, 2011.
18. Loenneke, JP, Fahs, CA, Rossow, LM, Abe, T, and Bemben, MG.
The anabolic benefits of venous blood flow restriction training may
be induced by muscle cell swelling. Med Hypotheses 78: 151–154,
19. Loenneke, JP, Fahs, CA, Rossow, LM, Sherk, VD, Thiebaud, RS,
Abe, T, Bemben, DA, and Bemben, MG. Effects of cuff width on
arterial occlusion: implications for blood flow restricted exercise.
Eur J Appl Physiol 112: 2903–2912, 2012.
20. Loenneke, JP, Fahs, CA, Thiebaud, RS, Rossow, LM, Abe, T, Ye, X,
Kim, D, and Bemben, MG. The acute muscle swelling effects of
blood flow restriction. Acta Physiol Hung 99: 400–410, 2012.
21. Loenneke, JP, Kearney, ML, Thrower, AD, Collins, S, and Pujol, TJ.
The acute response of practical occlusion in the knee extensors. The
J Strength Conditioning Res 24: 2831–2834, 2010.
22. Loenneke, JP and Pujol, TJ. The use of occlusion training to produce
muscle hypertrophy. Strength Conditioning J 31: 77–84, 2009.
23. Loenneke, JP, Thrower, AD, Balapur, A, Barnes, JT, and
Pujol, TJ. Blood flow-restricted walking does not result in an
accumulation of metabolites. Clin Physiol Funct Imaging 32: 80–
82, 2012.
24. Lowery,RP,Joy,JM,Loenneke,JP,deSouza,EO,
Machado, M, Dudeck, JE, and Wilson, JM. Practical blood flow
restriction training increases muscle hypertrophy during
a periodized resistance training programme. Clin Physiol Funct
Imaging 2013.
25. Manini, TM and Clark, BC. Blood flow restricted exercise and
skeletal muscle health. Exerc Sport Sci Rev 37: 78–85, 2009.
26. Mitchell, CJ, Churchward-Venne, TA, West, DW, Burd, NA,
Breen, L, Baker, SK, and Phillips, SM. Resistance exercise load does
not determine training-mediated hypertrophic gains in young men.
J Appl Physiol (1985) 113: 71–77, 2012.
Journal of Strength and Conditioning Research
VOLUME 28 | NUMBER 8 | AUGUST 2014 | 2279
Copyright © National Strength and Conditioning Association Unauthorized reproduction of this article is prohibited.
27. Reeves, GV, Kraemer, RR, Hollander, DB, Clavier, J,
Thomas, C, Francois, M, and Castracane, VD. Comparison of
hormone responses following light resistance exercise with
partial vascular occlusion and moderately difficult resistance
exercise without occlusion. J Appl Physiol (1985) 101: 1616–
1622, 2006.
28. Sale, DG. Influence of exercise and training on motor unit
activation. Exerc Sports Sci Rev 15: 95–151, 1987.
29. Takarada, Y, Nakamura, Y, Aruga, S, Onda, T, Miyazaki, S, and
Ishii, N. Rapid increase in plasma growth hormone after low-
intensity resistance exercise with vascular occlusion. J Appl Physiol
(1985) 88: 61–65, 2000.
30. Takarada, Y, Sato, Y, and Ishii, N. Effects of resistance exercise
combined with vascular occlusion on muscle function in athletes.
Eur J Appl Physiol 86: 308–314, 2002.
31. Takarada, Y, Takazawa, H, Sato, Y, Takebayashi, S, Tanaka, Y, and
Ishii, N. Effects of resistance exercise combined with moderate
vascular occlusion on muscular function in humans. J Appl Physiol
(1985) 88: 2097–2106, 2000.
32. Takarada, Y, Tsuruta, T, and Ishii, N. Cooperative effects of exercise
and occlusive stimuli on muscular function in low-intensity
resistance exercise with moderate vascular occlusion. Jpn J Physiol
54: 585–592, 2004.
33. Wernbom, M, Augustsson, J, and Thomee, R. The influence of
frequency, intensity, volume and mode of strength training on whole
muscle cross-sectional area in humans. Sports Med 37: 225–264, 2007.
34. West, DW and Phillips, SM. Anabolic processes in human skeletal
muscle: Restoring the identities of growth hormone and
testosterone. Phys Sportsmed 38: 97–104, 2010.
35. Wilson, JM, Lowery, RP, Joy, JM, Loenneke, JP, and Naimo, MA.
Practical blood flow restriction training increases acute determinants
of hypertrophy without increasing indices of muscle damage.
J Strength Cond Res 27: 3068–3075, 2013.
36. Yamanaka, T, Farley, RS, and Caputo, JL. Occlusion training
increases muscular strength in division IA football players. J Strength
Cond Res 26: 2523–2529, 2012.
37. Yasuda, T, Brechue, WF, Fujita, T, Shirakawa, J, Sato, Y, and
Abe, T. Muscle activation during low-intensity muscle contractions
with restricted blood flow. J Sports Sci 27: 479–489, 2009.
38. Yasuda, T, Loenneke, JP, Thiebaud, RS, and Abe, T. Effects of blood
flow restricted low-intensity concentric or eccentric training on
muscle size and strength. PLoS One 7: 1–7, 2012.
39. Yasuda,T,Ogasawara,R,Sakamaki,M,Ozaki,H,Sato,Y,and
Abe, T. Combined effects of low-intensity blood flow restriction
training and high-intensity resistance training on muscle
strength and size. Eur J Appl Physiol 111: 2525–2533, 2011.
Practical Blood Flow Restriction
Journal of Strength and Conditioning Research
Copyright © National Strength and Conditioning Association Unauthorized reproduction of this article is prohibited.
... It was the first study that provides data that suggests that LRT-BFR constitutes an important surrogate approach to HRT as an effective training method to induce gains in muscle strength and muscle mass in the elderly. Key node 2 is an article published in the Journal of Strength and Conditioning Research by Paul E. Luebbers in 2014, titled The effects of a 7-week practical blood flow restriction program on well-trained collegiate athletes 33) . The burst and centrality of this article are 4.45 and 0.6 respectively and it belongs to the same cluster as key node 1. ...
... 1. Participant: human beings were the most common research participant used to study the efficacy of BFR 30,33) . Recently, animals have been gradually included by researchers in this field to explore the deeper mechanisms of BFR, such as laboratory rats. ...
... Fry reported that LIRE in combination with BFR enhanced mTORC1 signaling and muscle protein synthesis (muscle protein synthesis, MPS) in older males 16) . In addition, a large number of studies have shown that BFR accelerated adaptations in human neuromuscular function and increase muscular function under ischemic conditions at a behavioral level 30,31,33,34) . ...
Full-text available
[Purpose] To assess the current state-of-the-art and the prevailing trends regarding the global use of blood flow restriction (BFR) in the past 20 years. [Participants and Methods] We retrieved literature relating to BFR from 1999 to 2020 using Web of Science. We conducted a bibliometric analysis of countries/institutions, cited journals, authors/cited authors, cited references, and keywords using CiteSpace. An analysis of counts and centrality was used to examine publication output, countries/institutions, core journals, active authors, foundation references, hot topics, and frontiers. [Results] Seven hundred seventy five references were included and the total number of publications has been continually increasing over the investigated period. Representatives of important academic groups are the Japanese scholars from the University of Tokyo as represented by Takashi Abe. Jeremy Paul Loenneke’s article (centrality: 0.15) was the most representative and symbolic reference with the highest centrality. The three topics identified were intervention (intensity resistance exercise, IRE), physiology (ischemia and muscular function) and behavior (adaptation and increase). The four frontier topics were phosphorylation, reduction, low intensity and arterial occlusion. [Conclusion] This study provides an insight into BFR and offers valuable information for BFR researchers to identify new perspectives for potential cooperation with collaborators and their related cooperative institutions.
... Despite the inferior effect on muscle strength, it is important to note that muscular strength does not diminish, and still improves marginally following LL-BFR -even when adopted for prolonged periods in well-trained individuals [24]. Indeed, when HL-RT and LL-BFR are combined together in the same training programme (as we propose later in this review), slow-velocity strength adaptations may be superior compared with HL-RT alone [14,36]. The influence of BFR on power-based qualities of the neuromuscular system is less certain. ...
... Performing BFR exercise after completing regular high-load exercise within a single session enhances bench press [14] and back squat [14,36] 1RM in well-trained American football players. Despite these strength improvements, hypertrophy (as inferred by girth measurements) only appeared to increase in the chest, with no differences in arm or thigh girth compared with a control group who completed LL training without BFR [14]. ...
Full-text available
Blood flow-restricted exercise is currently used as a low-intensity time-efficient approach to reap many of the benefits of typical high-intensity training. Evidence continues to lend support to the notion that even highly trained individuals, such as athletes, still benefit from this mode of training. Both resistance and endurance exercise may be combined with blood flow restriction to provide a spectrum of adaptations in skeletal muscle, spanning from myofibrillar to mitochondrial adjustments. Such diverse adaptations would benefit both muscular strength and endurance qualities concurrently, which are demanded in athletic performance, most notably in team sports. Moreover, recent work indicates that when traditional high-load resistance training is supplemented with low-load, blood flow-restricted exercise, either in the same session or as a separate training block in a periodised programme, a synergistic and complementary effect on training adaptations may occur. Transient reductions in mechanical loading of tissues afforded by low-load, blood flow-restricted exercise may also serve a purpose during de-loading, tapering or rehabilitation of musculoskeletal injury. This narrative review aims to expand on the current scientific and practical understanding of how blood flow restriction methods may be applied by coaches and practitioners to enhance current athletic development models.
... B. elastische Kniebandagen [18] oder rigide Bänder [129] verwendet, sodass auf sperrige, umständliche und kostspielige pneumatische Blutsperrgeräte verzichtet werden kann. So könnte beispielsweise ein größerer Kader einer American-Football-Mannschaft gleichzeitig mit BFR trainieren [104]. Die Breite der bisher in Studien verwendeten, elastischen Bandagen variiert dabei zwischen 5 -13 cm [11,197], wobei die am häufigsten verwendete Manschettenbreite bei 7 -8 cm lag [133,192] [197] angewendete Überlappungstechnik heraus. ...
... Dabei wird die nicht-pneumatische Manschette zunächst locker um die Extremität gelegt und anschließend zu einer vorgegebenen Überlappung zugezogen, um so die Restriktion des Blutflusses zu erzeugen [197]. Beim Zuziehen, also "Überlappen", wurden in Studien sowohl fixe Werte [104,197] [114]. Im Gegensatz dazu folgt einem Krafttraining eine Steigerung der koagulatorischen sowie fibrinolytischen Prozesse [120]. ...
Für eine optimale Steuerung von Trainingsumfängen und -intensitäten im Leistungssport oder in der Rehabilitation nach Verletzungen und Erkrankungen werden zunehmend neuartige Trainingsmethoden integriert. Das Blutflussrestriktionstraining (engl. Blood-Flow-Restriction Training, BFR) beschreibt eine dieser neuen Trainingsmethoden, bei der es zu einer Anwendung von speziellen Blutdruckmanschetten während der Belastung an den Extremitäten kommt. Das vorliegende Positionspapier zielt darauf ab, eine umfassende Beschreibung der BFR-Trainingsmethode, deren bisher dargestellten Wirkmechanismen und möglichen unerwünschten Wirkungen zu geben.
... A total of 1,070 English articles and 295 Chinese articles were retrieved, and 29 English articles Beekley et al., 2005;Yasuda et al., 2005;Fujita et al., 2008;Madarame et al., 2008;Abe et al., 2010a;Abe et al., 2010b;Park et al., 2010;Sumide et al., 2010;Madarame et al., 2011;Tomohiro et al., 2011;Yasuda et al., 2011;Godawa et al., 2012;Keramidas et al., 2012;Martín-Hernández et al., 2012;Tetsuo et al., 2012;Luebbers et al., 2014;Yasuda et al., 2014;Barcelos et al., 2015;Fahs et al., 2015;Lixandrão et al., 2015;Vechin et al., 2015;Yasuda et al., 2015;Kim et al., 2016;Luebbers et al., 2017;Slysz and Burr, 2017;Bjørnsen et al., 2019;Harper et al., 2019;Schwiete et al., 2021;Teixeira et al., 2021) and 5Chinese articles (Liu et al., 2018;Lu Zhang et al., 2020;Li et al., 2022;Tang and Qu, 2022) were included in the meta-analysis. The flow diagram of the study selection is shown in Figure 1. ...
... Moreover, studies showed that blood flow restriction training did not increase muscle activation at high load (70% 1RM) (Takarada et al., 2002) and decreased muscle activation at > 70% 1RM (Dankel et al., 2017). In addition, blood flow restriction training at 80% 1RM showed no significant improvement in muscle hypertrophy and strength (Luebbers et al., 2014;Winchester et al., 2020). As muscle resistance increases, muscle contraction has internal restrictions on blood flow, and external cuff pressure may fail to produce a positive effect. ...
Full-text available
Objective: To perform a meta-analysis on the efficacy and dose-response relationship of blood flow restriction training on muscle strength reported worldwide. Methods: Thirty-four eligible articles with a total sample size of 549 participants were included in the meta-analysis. This study was performed using the method recommended by the Cochrane Handbook ( ), and the effect size was estimated using the standardized mean difference (SMD) and using RevMan 5.3 software (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, 2014). Results: The meta-analysis showed that blood flow restriction training increased the lower limb extensor muscle strength [SMD = 0.72, 95%; confidence interval (CI): 0.43 to 1.00, p < 0.01], knee extensor isokinetic torque SMD = 0.48 [95% CI: 0.24 to 0.73, p < 0.01], knee flexor isokinetic torque SMD = 0.39 [95% CI: 0.11 to 0.67, p < 0.01], and squat one-repetition maximum [SMD = 0.28, 95% CI: 0.01 to 0.55, p < 0.01]. There was no publication bias. Evaluation of dose-response relationship showed that the training load, mode, frequency, duration, and maximum cuff pressure affected the muscle function. Conclusion : blood flow restriction training. 16 significantly improved lower limb muscle strength, and the optimal training conditions consisted of a weight load smaller or equal to 30% of one-repetition maximum, training duration longer than 4 weeks, frequency of more than 3 times/week, and maximum cuff pressure lower than 200 mmHg. Systematic Review Registration: website, identifier registration number.
... The use of elastic bands, first proposed by Loenneke and Pujol (2009) represents a more practical option due to their lower cost and greater accessibility in relation to inflatable cuffs (Wilson et al., 2013). In this context, a considerable number of studies have evaluated the acute and chronic effects of practical BFR resistance exercise (p-BFR), compared to non-BFR resistance exercise (low-or high-load) or to resistance exercise with traditional BFR (t-BFR) (Bjørnsen et al., 2019;Freitas et al., 2020;Loenneke et al., 2012;Luebbers et al., 2014;Miller et al., 2020;Oliveira et al., 2020;Wilson et al., 2013). Commonly, the pressure applied in training with p-BFR was based on an 11-point perceived discomfort scale. ...
Our purpose in this study was to analyze perceptual and cardiovascular responses in low-load resistance training (RT) sessions associated with a fixed non-elastic band compressed to the proximal region of the arms (p-BFR) versus a pneumatic cuff inflated to a pressure of 150 mmHg (t-BFR). Participants (16 healthy trained men) were randomly assigned to two conditions of low-load RT (20% one repetition maximum [1RM]) with BFR (p-BFR or t-BFR). In both conditions, the participants performed five exercises (4 sets/30-15-15-15) for the upper-limbs, but in one of the conditions, the exercises were performed with a p-BFR induced by a non-elastic band, while in the other, the exercises were performed with a t-BFR using a device with similar width. The devices used to generate the BFR had similar widths (5 cm). Brachial blood pressure (bBP) and heart rate (HR) were measured before, after each exercise and after the experimental session (5-, 10-, 15-, and 20 min post-session). Rating of perceived exertion (RPE) and rating of pain perception (RPP) were reported after each exercise and 15 minutes post-session. HR increased during the training session in both conditions, with no differences between p-BFR and t-BFR. Neither intervention increased diastolic BP (DBP) during training, but there was a significant post-session reduction in DBP in the p-BFR, with no differences observed between conditions. There were no significant differences in RPE and RPP in the two training conditions, with both conditions associated with higher RPE and RPP at the end versus beginning of the experimental session. We conclude that when BFR device width and material are similar, low-load training with t-BFR and p-BFR promotes similar acute perceptual and cardiovascular responses in healthy trained men.
... However, current recommendations for a training frequency of 2-4 times per week, mirror those of traditional resistance training for strength and hypertrophy increases [59][60][61][62]. Despite variances in the duration of BFRT interventions, three weeks or longer is typically advocated as a prerequisite for adequate strength and hypertrophy adaptations to occur [63][64][65]. Considerations of cuff application in BFRT are also important, with key variables of cuff pressure, width and material requiring attention [66,67]. Arterial occlusion pressure is the amount of pressure required to cease blood-flow within the targeted limb, which varies between individuals subject to characteristics such as body size and health status [68,69]. ...
Full-text available
Tendinopathy is a chronic tendon disease which can cause significant pain and functional limitations for individuals, and which collectively places a tremendous burden on society. Resistance training has long been considered the treatment of choice in the rehabilitation of chronic tendinopathies, with both eccentric and heavy slow resistance training demonstrating positive clinical effects. The application of progressive tendon loads during rehabilitation is essential to not compromise tendon healing, with the precise dosage parameters of resistance training and external loading a critical consideration. Blood-flow restriction training (BFRT) has become an increasingly popular method of resistance training in recent years and has been shown to be an effective method for enhancing muscle strength and hypertrophy in healthy populations and in musculoskeletal rehabilitation. Traditional resistance training for tendinopathy requires the application of heavy training loads, whereas BFRT utilises significantly lower loads and training intensities, which may be more appropriate for certain clinical populations. Despite evidence confirming the positive muscular adaptations derived from BFRT and the clinical benefits found for other musculoskeletal conditions, BFRT has received a dearth of attention in tendon rehabilitation. Therefore, the purpose of this narrative review was threefold: firstly, to give an overview and analysis of the mechanisms and outcomes of BFRT in both healthy populations and in musculoskeletal rehabilitation. Secondly, to give an overview of the evidence to date on the effects of BFRT on healthy tendon properties and clinical outcomes when applied to tendon pathology. Finally, a discussion on the clinical utility of BFRT and its potential applications within tendinopathy rehabilitation, including as a compliment to traditional heavy-load training, is presented.
... In Japan, Dr. Yoshiaki Sato promoted "kaatsu training", involving "training with added pressure" through which BFR became widely known to the general public [2]. In typical BFR training, a cuff/tourniquet system is used to apply a partial restriction to the arterial inflow in the working musculature during exercise, while the venous outflow is completely restricted [3] so that the consequent blood pooling allows for an increased training effect [4]. Recent evidence has indicated the superiority of the reinforced training stimuli using the combined BFR training compared to the same exercise without BFR training [5]. ...
Full-text available
This study investigated the effect of low-intensity aerobic training combined with blood flow restriction (LABFR) on body composition, physical fitness, and vascular functions in recreational runners. The participants were 30 healthy male recreational runners, randomized between the LABFR (n = 15) and control (n = 15) groups. The LABFR group performed five sets of a repeated pattern of 2 min running at 40% VO2max and 1 min passive rest, while wearing the occlusion cuff belts on the proximal end of the thigh. The frequency was three times a week for the period of eight weeks. The control group performed the identical running protocol without wearing the occlusion cuff belts. At the end of the training, the participants’ body composition (fat mass, body fat, muscle mass, and right and left thigh circumference), physical fitness (power and VO2max), and vascular responses (flow-mediated dilation (FMD), brachial ankle pulse wave velocity (baPWV), ankle brachial index (ABI), systolic blood pressure (SBP) and diastolic blood pressure (DBP)) were measured. The results showed a significant time × group interaction effect on muscle mass (F = 53.242, p = 0.001, ηp2 = 0.664) and right thigh circumference (F = 4.544, p = 0.042, ηp2 = 0.144), but no significant variation in any other factors, including fat mass, body fat, left thigh circumference, FMD, baPWV, ABI, SBP, and DBP (p > 0.05). Overall, our results suggested that eight-week LABFR exerted a positive effect on the body composition, especially muscle mass and thigh circumference, of recreational runners.
Full-text available
The purpose of this systematic review and meta-analysis was to compare changes in explosive power between blood flow restriction training and traditional resistance training protocols. Searches of PubMed, Scopus, Web of Science, and OVID Medline were conducted for studies. Inclusion criteria were: (a) healthy people; (b) randomized controlled or controlled trials; (c) outcome measures of explosive performance (peak power, rate of force development, jump performance, sprint performance, etc.); (d) involving a comparison between blood flow restriction training and traditional resistance training. Quality assessment was conducted using the Physiotherapy Evidence Database (PEDro) scale. A total of 12 studies (262 subjects) were finally included for analysis. The PEDro scale score had a median of 5 of 10 points (range: 3–6 points). Significant small to moderate improvements were observed in blood flow restriction training [jump: standard mean difference (SMD) of 0.36 (95% CI: 0.02; 0.69); sprint: SMD of 0.54 (95% CI: 0.00; 1.07); power: SMD of 0.72 (95% CI: 0.17; 1.27)] when compared to traditional resistance training. The findings indicate that blood flow restriction training is more effective in improving explosive power of lower limbs compared to traditional resistance training in healthy people. In addition, blood flow restriction with a wide cuff ( 10 cm) during training improved explosive power better than with a narrow cuff or during the rest interval. Blood flow restriction training is very suitable for athletes in short competitive seasons and those who are not able to tolerate high loads (i.e., rehabilitators and the elderly).
Athletes can experience loss of muscle mass and function for multiple reasons following a sports injury, surgery, fracture, or joint degeneration. High load resistance training is often contraindicated early on in rehabilitation. Low-load blood flow restriction (BFR) training has beneficial effects on skeletal muscle strengthening while avoiding the risks of heavy loads. BFR can be used in a wide range of clinical applications including prehabilitation, rehabilitation, potentially reducing return to sport timelines. It may assist athletes looking for those marginal gains when their current training program has plateaued. Managing or preventing musculoskeletal injuries in a sports setting can be challenging with a plethora of modalities and options to facilitate rehabilitation and recovery. Dry Needling and Cupping Therapy may be beneficial in reducing pain. While cryotherapy can be used for pain relief and recovery, it has recently been discouraged in the management of acute soft tissue injuries. New innovations in manual therapy, including foam rolling, percussive massage devices, and instrument-assisted soft tissue mobilization, extrapolate their benefit primarily from sports massage promoting pain relief, increased flexibility, and faster recovery. They are popularized for allowing “self-massage.” Muscle energy and active release techniques aim to reduce pain, increase range of motion (ROM) and facilitate optimal tissue healing. All these innovations may have a role in managing an endurance athlete through rehabilitation, training, competition, recovery, and injury prevention; however most require more high quality research with greater homogeneity across samples, methods, measurements, and treatment protocols in the future.KeywordsBlood flow restrictionCuppingDry needlingPercussive massageInstrument-assisted massageCryotherapyFoam rollingMETRecoverySelf-massageMassage device
Full-text available
To investigate the effect of acute changes of extracellular osmolality on whole body protein and glucose metabolism, we studied 10 male subjects during three conditions: hyperosmolality was induced by fluid restriction and intravenous infusion of hypertonic NaCl [2-5%; (wt/vol)] during 17 h; hypoosmolality was produced by intravenous administration of desmopressin, liberal water drinking, and infusion of hypotonic saline (0.4%); and the isoosmolality study consisted of ad libitum oral water intake by the subjects. Leucine flux ([1-13C]leucine infusion technique), a parameter of whole body protein breakdown, decreased during the hypoosmolality study ( P < 0.02 vs. isoosmolality). The leucine oxidation rate decreased during the hypoosmolality study ( P < 0.005 vs. isoosmolality). Metabolic clearance rate of glucose during hyperinsulinemic-euglycemic clamping increased less during the hypoosmolality study than during the isoosmolality study ( P < 0.04). Plasma insulin decreased, and plasma nonesterified fatty acids, glycerol, and ketone body concentrations and lipid oxidation increased during the hypoosmolality study. It is concluded that acute alterations of plasma osmolality influence whole body protein, glucose, and lipid metabolism; hypoosmolality results in protein sparing associated with increased lipolysis and lipid oxidation and impaired insulin sensitivity.
Full-text available
Blood flow restricted (BFR) resistance exercise has become a popular area of research. However, studies use a range of blood flow restriction and resistance exercise protocols. Objectives: To provide an overview of the methods used for BFR resistance exercise for individuals interested in utilizing BFR training and for researchers studying the acute and chronic effects of BFR resistance exercise. Design: A systematic review. Method: BFR resistance training studies with muscular strength and hypertrophy as main outcomes were identified. Resistance exercise protocol and blood flow restriction protocol were compared between these studies. Acute BFR resistance exercise studies comparing different BFR protocols were also examined. Results: Continuous, partial arterial blood flow restriction during resistance exercise appears to be tolerable and effective for increasing both limb and trunk muscle strength and hypertrophy. Compared to non-BFR exercise, blood flow restriction produces an additive effect when combined with resistance exercise loads of <50% one-repetition maximum. Optimal BFR resistance training frequency may be higher (2x daily) than high-load resistance exercise. Conclusions: Restrictive cuff size, pressure, and limb circumference affect the degree of blood flow restriction and should be carefully considered when performing or prescribing BFR resistance exercise. The volume and frequency of BFR resistance exercise may depend on the trainee&apos;s capabilities and goals.
Full-text available
The purpose of this study was to investigate the effects of short-term KAATSU-resistance training on skeletal muscle size and sprint/jump performance in college athletes. Fifteen male track and field college athletes were randomly divided into two groups: KAATSU (resistive exercise combined with blood flow restriction, n=9) and control (n=6) groups. The KAATSU group trained twice daily with squat and leg curl exercises (20% of 1-RM, 3 sets of 15 repetitions) for 8 consecutive days while both KAATSU and control groups participated in the regular sprint/jump training sessions. Maximal strength, muscle-bone CSA, mid-thigh muscle thickness (MTH), and sprint/jump performance were measured before and after the 8 days of training. The muscle-bone CSA increased 4.5% (p 0.05) in the control group. Quadriceps and hamstrings MTH increased (p 0.05) in the control group. Overall 30-m dash times improved (p 0.05) for either the KAATSU or control groups. These data indicated that eight days of KAATSU-training improved sprint but not jump performance in collegiate male track and field athletes.
Resistance training in combination with practical blood flow restriction (pBFR) is thought to stimulate muscle hypertrophy by increasing muscle activation and muscle swelling. Most previous studies used the KAATSU device; however, little long-term research has been completed using pBFR. To investigate the effects of pBFR on muscle hypertrophy. Twenty college-aged male participants with a minimum of 1 year of resistance training experience were recruited for this study. Our study consisted of a randomized, crossover protocol consisting of individuals either using pBFR for the elbow flexors during the first 4 weeks (BFR-HI) or the second 4 weeks (HI-BFR) of an 8-week resistance training programme. Direct ultrasound-determined bicep muscle thickness was assessed collectively at baseline and at the end of weeks 4 and 8. There were no differences in muscle thickness between groups at baseline (P = 0·52). There were time (P<0·01, ES = 0·99) but no condition by time effects (P = 0·58, ES = 0·80) for muscle thickness in which the combined values of both groups increased on average from week 0 (3·66 ± 0·06) to week 4 (3·95 ± 0·05) to week 8 (4·11 ± 0·07). However, both the BFR-HI and HI-BFR increased significantly from baseline to week 4 (6·9% and 8·6%, P<0·01) and from weeks 4 to 8 (4·1%, 4·0%, P<0·01), respectively. The results of this study suggest that pBFR can stimulate muscle hypertrophy to the same degree to that of high-intensity resistance training.
The purpose of this study was to examine the daily skeletal muscle hypertrophic and strength responses to one week of twice daily KAATSU training, and follow indicators of muscle damage and inflammation on a day-to-day basis, for one subject. KAATSU training resulted in a 3.1% increase in muscle-bone CSA after 7 days of training. Both MRI-measured maximum quadriceps muscle cross-sectional area (Q-CSA max) and muscle volume can be seen increasing after the first day of KAATSU training, and continuously increasing for the rest of the training period. Following 7 days KAATSU resistance training, the increases in Q-CSA max and muscle volume were 3.5% and 4.8%, respectively. Relative strength (isometric knee extension strength per unit Q-CSA max) was increased after training (before, 3.60 Nm/cm2; after, 4.09 Nm/cm2). There were very modest increases in CK and myoglobin after a single bout of KAATSU exercise in the first day of the training, but the values were return towards normal at 2 days after the training. IL-6 remained unchanged throughout the training period. In conclusion, our subject gained absolute strength and increased muscle size after only one week of low intensity KAATSU resistance training. Indicators of muscle damage and inflammation were not elevated by this training. KAATSU training appears to be a safe and effective method to rapidly induce skeletal muscle strength and hypertrophy.
SUMMARY In order to stimulate further adaptation toward specific training goals, progressive resistance training (RT) protocols are necessary. The optimal characteristics of strength-specific programs include the use of concentric (CON), eccentric (ECC), and isometric muscle actions and the performance of bilateral and unilateral single- and multiple-joint exercises. In addition, it is recommended that strength programs sequence exercises to optimize the preservation of exercise intensity (large before small muscle group exercises, multiple-joint exercises before single-joint exercises, and higher-intensity before lower-intensity exercises). For novice (untrained individuals with no RT experience or who have not trained for several years) training, it is recommended that loads correspond to a repetition range of an 8-12 repetition maximum (RM). For intermediate (individuals with approximately 6 months of consistent RT experience) to advanced (individuals with years of RT experience) training, it is recommended that individuals use a wider loading range from 1 to 12 RM in a periodized fashion with eventual emphasis on heavy loading (1-6 RM) using 3- to 5-min rest periods between sets performed at a moderate contraction velocity (1-2 s CON; 1-2 s ECC). When training at a specific RM load, it is recommended that 2-10% increase in load be applied when the individual can perform the current workload for one to two repetitions over the desired number. The recommendation for training frequency is 2-3 dIwkj1 for novice training, 3-4 dIwkj1 for intermediate training, and 4-5 dIwkj1 for advanced training. Similar program designs are recom- mended for hypertrophy training with respect to exercise selection and frequency. For loading, it is recommended that loads corresponding to 1-12 RM be used in periodized fashion with emphasis on the 6-12 RM zone using 1- to 2-min rest periods between sets at a moderate velocity. Higher volume, multiple-set programs are recommended for maximizing hypertrophy. Progression in power training entails two general loading strategies: 1) strength training and 2) use of light loads (0-60% of 1 RM for lower body exercises; 30-60% of 1 RM for upper body exercises) performed at a fast contraction velocity with 3-5 min of rest between sets for multiple sets per exercise (three to five sets). It is also recommended that emphasis be placed on multiple-joint exercises especially those involving the total body. For local muscular endurance training, it is recommended that light to moderate loads (40-60% of 1 RM) be performed for high repetitions (915) using short rest periods (G90 s). In the interpretation of this position stand as with prior ones, recommendations should be applied in context and should be contingent upon an individual's target goals, physical capacity, and training
Vascular blood flow restriction (vBFR) training stimulates muscle hypertrophy by increasing muscle activation and muscle swelling. Previous studies used expensive pneumatic cuffs, which may not be practical for regular use. PURPOSE:: To investigate the acute effects of low intensity practical BFR (LI-pBFR) on muscle activation, muscle swelling and damage. METHODS:: Twelve trained male participants completed a 30, 15, 15, 15 repetition scheme at 30% of their leg press 1-RM under control and LI-BFR conditions. Under the LI-BFR trial, knee wraps were applied to the thighs at a pressure which resulted in venous, not arterial, occlusion. In the control trial, wraps were applied with zero pressure. Ultrasound determined muscle thickness was recorded at baseline, 0 minutes post with wraps, 0, 5 and 10 minutes post without wraps. Muscle activation was recorded during warm ups and on the final set of 15 repetitions. Indices of muscle damage (soreness, power, and muscle swelling) were also recorded. RESULTS:: There was a condition by time effect for muscle thickness (p < 0.0001, ES = 0.5), in which muscle thickness increased in the LI-pBFR condition 0 minutes post with wraps and through 5 minutes post without wraps. No changes occurred in the control. There was a condition by time effect for muscle activation (p < .05, ES = 0.2). LI-pBFR had greater activation than the control. There were no condition by time effects on indices of muscle damage. DISCUSSION:: Our data indicates that practical BFR significantly increases muscle activation and muscle thickness without increasing indices of damage.